Economic impact of contrast-induced acute kidney injury associated with invasive cardiology: role of iso-osmolar contrast media in Germany, Italy, Poland, and Spain

Abstract

Objective:

Iso-osmolar Iodixanol is associated with a lower rate of contrast-induced acute kidney injury (CI-AKI) in patients at increased risk compared to low-osmolar contrast media (LOCM). The aim of this study was to assess the financial consequences of CI-AKI risk reduction in patients undergoing coronary angiography (CA) with or without percutaneous coronary intervention (PCI) in German, Italian, Polish and Spanish hospitals.

Methods:

This budget impact analysis (BIA) compared a scenario with iodixanol to a scenario without, where only LOCM were used, in patients at increased risk of CI-AKI over a 3-year horizon. A meta-analysis based on a systematic review observed a lower rate of CI-AKI with iodixanol compared to LOCM (Risk Reduction = 0.46) in patients with underlying impaired renal function (serum creatinine ≥1.6 mg/dl and estimated glomerular filtration rate ≤50 ml/min/1.73 m²). Contrast media and CI-AKI hospitalization costs were included in the analysis and unit costs were obtained from published literature, official sources or, when available, from hospital data. In the absence of country-specific data, resource utilization for a CI-AKI hospitalization was obtained by interviews with local clinicians in each country. The percentage of patients who received iodixanol was assumed to increase over time.

Results:

Based on a percentage of patients at increased risk of CI-AKI equal to 20% in Germany, 24% in Italy, 23% in Poland and 10% in Spain, results showed that the introduction of iodixanol would bring a 3-years cumulative net percentage saving on the total hospital budget of 29%, 34%, 25%, and 33% in the four countries respectively.

Conclusion:

The results of the analysis for the four countries showed that iodixanol use in patients at increased risk of CI-AKI undergoing CA with or without PCI may bring considerable savings on the hospital’s budget, due to the associated reduction in CI-AKI incidence.

Keywords::

• Budget impact
• Contrast media
• Acute kidney injury
• Iodixanol

Transparency

Declaration of funding

GE Healthcare provided funding for this manuscript.

Declaration of financial/other relationships

GE Healthcare contracted IMS Health to develop the model and conduct the present study in Germany, Italy, Poland, and Spain. ML and MDF are employees of IMS Health. CR, PJW, RW, and FH received a consulting fee of GE Healthcare. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors of this paper acknowledge the contribution given by IMS Health team members Stijn Vandekerckhove, Roger-Axel Greiner and Carmen Barrull in the adaptation of the model to local setting, by GE Healthcare team members who supported the development of the project, by the Key Opinion Leaders involved in the advisory boards that took place in each country (Spain: Dr Angel L.M. de Francisco, Dr José María Hernández, Dr Fina Mauri, Dr Francisco Picó-Aracil, Dr Eduardo Pinar, Dr Rafael Ruiz-Salmerón. Germany: Prof Bernd Hohenstein, Prof Peter Grob, Prof Dr Matthias Girndt, Dr Klaus Thürmel, Dr Frank Burger, PD, Dr Johannes Rieber, Dr Michaela Klauck, Dr Ji-Hyun You, Dr med. Frank van Buuren. Italy: Dr Antonio Manari, Dr Marcello Pani. Poland: Dr Sławomir Dobrzycki, Dr Robert Juszkat, Dr Jacek Kubica, Dr Maciej Lesiak, Dr Michał Nowicki, Dr Andrzej Ochała, Dr Przemyslaw Rutkowski, Dr Piotr Waciń ski, Dr Adam Zapaśnik, Dr Janusz Kochman, Dr Aleksander Falkowski, Dr Rafał Donderski).