ABSTRACT

Introduction

Though cost-effectiveness analyses (CEAs) have evaluated continuous renal replacement therapy (RRTs) and intermittent RRTs in acute kidney injury (AKI) patients; it is yet to establish which RRT technique is most cost-effective. We systematically reviewed the current evidence from CEAs of CRRT versus IRRT in patients with AKI.

Areas covered

PubMed, EMBASE, and Cochrane databases searched for CEAs comparing two RRTs. Overall, seven CEAs, two from Brazil and one from US, Canada, Colombia, Belgium, and Argentina were included. Five CEAs used Markov model, three reported following CHEERS, none accounted indirect costs. Time horizon varied from 1-year–lifetime. Marginal QALY gain with CRRT compared to IRRT was reported across CEAs. Older CEAs found CRRT to be costlier and not cost-effective than IRRT (ICER 2019 US$: 152,671$/QALY); latest CEAs (industry-sponsored) reported CRRT to be cost-saving versus IRRT (−117,614$/QALY). Risk of mortality, dialysis dependence, and incidence of renal recovery were the key drivers of cost-effectiveness.

Expert opinion

CEAs of RRTs for AKI show conflicting findings with secular trends. Latest CEAs suggested CRRT to be cost-effective versus IRRT with dialysis dependence rate as major driver of cost-effectiveness. Future CEAs, preferably non-industry sponsored, may account for indirect costs to improve the generalizability of CEAs.

中文翻译：

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急性肾损伤连续与间歇性肾脏替代治疗成本效益分析的系统评价

摘要

介绍

尽管成本效益分析 (CEA) 已经评估了急性肾损伤 (AKI) 患者的连续肾脏替代疗法 (RRT) 和间歇性 RRT；目前尚未确定哪种 RRT 技术最具成本效益。我们系统地回顾了 AKI 患者中 CRRT 与 IRRT 的 CEA 的当前证据。

涵盖的领域

PubMed、EMBASE 和 Cochrane 数据库搜索了比较两种 RRT 的 CEA。总体而言，包括七个 CEA，两个来自巴西，一个来自美国、加拿大、哥伦比亚、比利时和阿根廷。五个 CEA 使用马尔可夫模型，三个报告遵循 CHEERS，没有一个考虑间接成本。时间跨度从 1 年到终生不等。CEA 报告了 CRRT 与 IRRT 相比的边际 QALY 增益。较早的 CEA 发现 CRRT 比 IRRT 更昂贵且不具有成本效益（ICER 2019 美元：152,671 美元/QALY）；最新的 CEA（行业赞助）报告说 CRRT 比 IRRT 更节省成本（-117,614 美元/QALY）。死亡风险、透析依赖和肾脏恢复的发生率是成本效益的关键驱动因素。

专家意见

AKI RRT 的 CEA 显示出与长期趋势相矛盾的结果。最新的 CEA 建议 CRRT 与 IRRT 相比具有成本效益，而透析依赖率是成本效益的主要驱动因素。未来的 CEA，最好是非行业赞助的，可能会考虑间接成本，以提高 CEA 的普遍性。