A systematic review of cost-effectiveness analyses of continuous versus intermittent renal replacement therapy in acute kidney injury

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.

KEYWORDS:

• Acute kidney injury
• cost-effectiveness analysis
• CRRT
• dialysis
• health economics
• IRRT
• systematic review

Informed consent

For this type of study, formal consent is not required.

Research involving human and/or animal participants

This article does not contain any studies with human participants or animals performed by any of the authors.

Declaration of interest

The authors declare that they have no conflict of interest.

Author contribution

AS: Protocol/project development, Data collection or management, Data analysis, Manuscript writing; SH: Data collection or management, Data analysis, Manuscript writing. VK: Data analysis, Manuscript editing. AJP: Data analysis, Manuscript editing. MJ: Data analysis, Manuscript editing. BA: Protocol/project development, Manuscript writing/editing.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This research received no specific funding.