The Cost-Effectiveness of Continuous Versus Intermittent Renal Replacement Therapies in Acute Kidney Injury: Perspective of the Social Services for the Elderly in Argentina

GARAY, OSVALDO ULISES; PALACIOS, ALFREDO; PICHON-RIVIERE, ANDRÉS; AUGUSTOVSKI, FEDERICO; MARTÍ, SEBASTIÁN GARCÍA; HERNÁNDEZ-VÁSQUEZ, AKRAM; LÓPEZ, ELENA TAPIA; ROSA-DÍEZ, GUILLERMO; BARDACH, ARIEL

Value in Health Regional Issues

Elsevier

Año: 2019 vol. 20 p. 142 - 148

2212-1099

Background: Acute kidney injury (AKI) is a public health problem that affects millions of hospitalized patients worldwide. In Argentina, ev- idence suggests that its incidence has risen in recent years. When severe, AKI may require a renal replacement therapy (RRT) where continuous RRT (CRRT) and intermittent RRT (IRRT) are plausible op- tions for patients in the intensive care unit. Objective: To evaluate the cost utility of CRRT versus IRRT for the National Institute of Social Services for Retirees and Pensioners, the largest social security health insurance for elders in Argentina. Methods: This was a model-based cost-utility analysis. Long-term costs and health outcomes were esti- mated for a hypothetical cohort with a Markov model. Parameters used were obtained from published literature and validated with local experts. Local costs were estimated and expressed in $AR of 2016. Several sensitivity analyses were run to analyze the impact of uncertainty on results. Results: Continuous RRT dominated IRRT by cumulating over the model more quality-adjusted life years and less costs. TotalIntroductionAcute kidney injury (AKI) is a public health problem that affects millions of hospitalized patients worldwide. It is associated with increased mortality, longer hospital stays, high financial costs, and increased risk of developing chronic diseases.1e3 Owing to its high incidence, it represents one of the most frequent reasons for consultation in nephrology departments.4 Estimations of preva- lent cases range from 2000 to 15 000 patients per million people per year.5,6 The multinational AKI-EPI study, which included 1032 intensive care unit (ICU) patients from 97 centers in 33 countries, found that 57.3% of patients suffered AKI during hospitalization, with sepsis and hypovolemia as the most common etiologies.7discounted quality-adjusted life years for both cohorts were 1049 and 1034, respectively, and total costs were $95 362 and $103 871. Cost- effectiveness (CE) results reflect these differences in favor of CRRT with a deterministic cost-saving incremental CE ratio and a probability of CRRT being CE of 65.4%, considering a CE threshold of 1 gross do- mestic product per capita. Conclusions: Continuous RRT for patients with AKI eligible for CRRT or IRRT would probably be a cost-effective intervention for the National Institute of Social Services for Retirees and Pensioners? view. Nevertheless, there is considerable uncertainty around results, mainly due to the lack of adequate controlled studies and local data on the prognosis of these patients in Argentina.