Management of acute kidney injury in the intensive care unit: a cost-effectiveness analysis of daily vs alternative-day hemodialysis

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Management of acute kidney injury in the intensive care unit: a cost-effectiveness analysis of daily vs alternative-day hemodialysis

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Title: Management of acute kidney injury in the intensive care unit: a cost-effectiveness analysis of daily vs alternative-day hemodialysis
Author: Desai, Amar A.; Baras, Jacqueline; Berk, Benjamin B.; Nakajima, Aya; Garber, Alan M; Owens, Douglas; Chertow, Glenn M.

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Citation: Desai, Amar A., Jacqueline Baras, Benjamin B. Berk, Aya Nakajima, Alan M. Garber, Douglas Owens, and Glenn M. Chertow. 2008. Management of acute kidney injury in the intensive care unit. Archives of Internal Medicine 168, 16:1761-1767.
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Abstract: Background Although evidence suggests that a higher hemodialysis dose and/or frequency may be associated with improved outcomes, the cost-effectiveness of a daily hemodialysis strategy for critically ill patients with acute kidney injury (AKI) is unknown.

Methods We developed a Markov model of the cost, quality of life, survival, and incremental cost-effectiveness of daily hemodialysis, compared with alternate-day hemodialysis, for patients with AKI in the intensive care unit (ICU). We employed a societal perspective with a lifetime analytic time horizon. We modeled the efficacy of daily hemodialysis as a reduction in the relative risk of death on the basis of data reported in the 2004 clinical trial published by Schiffl et al. We performed 1- and 2-way sensitivity analyses across cost, efficacy, and utility input variables. The main outcome measure was cost per quality-adjusted life-year (QALY).

Results In the base case for a 60-year-old man, daily hemodialysis was projected to add 2.14 QALYs and $10 924 in cost. We found that the cost-effectiveness of daily hemodialysis compared with alternate-day hemodialysis was $5084 per QALY gained. The incremental cost-effectiveness ratio became less favorable (>$50 000 per QALY gained) when the maintenance hemodialysis rate of the daily hemodialysis group was varied to more than 27% and when the difference in 14-day postdischarge mortality between the alternatives was varied to less than 0.5%.

Conclusion Daily hemodialysis is a cost-effective strategy compared with alternate-day hemodialysis for patients with severe AKI in the ICU.
Published Version: doi:10.1001/archinte.168.16.1761
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:11577347
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