Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury

Jacobsen, Elisabet; Sawhney, Simon; Brazzelli, Miriam; Aucott, Lorna; Scotland, Graham; Aceves‐Martins, Magaly; Robertson, Clare; Imamura, Mari; Poobalan, Amudha; Manson, Paul; Kaye, Callum; Boyers, Dwayne

doi:10.1186/s12882-021-02610-9

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…e ESRD reported as CKD stage 5 in Kent et al 113 f This cost is based on the total annual cost of both erythropoiesis-stimulating agent medication and blood pressure medication (see calculation in Appendix 13, Tables 35 and 36. Reproduced with permission from Jacobsen et al 104 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/ licenses/by/4.0/.…”

Section: Diagnostic Test Costsmentioning

confidence: 99%

“…e For application in the model, the ESRD (dialysis) utility is applied as the weighted average utility based on the proportion of long-term dialysis delivered as haemodialysis and peritoneal dialysis, obtained from the UK Renal Registry report. 115 Reproduced with permission from Jacobsen et al 104 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/ licenses/by/4.0/.…”

Section: Acute (Decision Tree) Phase Of the Modelmentioning

confidence: 99%

“…those that generate higher costs for lower QALYs) were then excluded from ICER calculations. Reproduced with permission from Jacobsen et al104 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/ by/4.0/.…”

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confidence: 99%

“…Diagnostic accuracy data used for cardiac surgery subgroup Note that, in the absence of meta-analysed studies for this subgroup, all correlations are assumed equal to the all-comers' base-case analysis. Reproduced with permission from Jacobsen et al104 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/ licenses/by/4.0/.…”

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Biomarkers for assessing acute kidney injury for people who are being considered for admission to critical care: a systematic review and cost-effectiveness analysis

Brazzelli

Aucott

Aceves‐Martins

et al. 2022

Health Technol Assess

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Background Acute kidney injury is a serious complication that occurs in the context of an acute critical illness or during a postoperative period. Earlier detection of acute kidney injury may facilitate strategies to preserve renal function, prevent further disease progression and reduce mortality. Acute kidney injury diagnosis relies on a rise in serum creatinine levels and/or fall in urine output; however, creatinine is an imperfect marker of kidney function. There is interest in the performance of novel biomarkers used in conjunction with existing clinical assessment, such as NephroCheck® (Astute Medical, Inc., San Diego, CA, USA), ARCHITECT® urine neutrophil gelatinase-associated lipocalin (NGAL) (Abbott Laboratories, Abbott Park, IL, USA), and urine and plasma BioPorto NGAL (BioPorto Diagnostics A/S, Hellerup, Denmark) immunoassays. If reliable, these biomarkers may enable earlier identification of acute kidney injury and enhance management of those with a modifiable disease course. Objective The objective was to evaluate the role of biomarkers for assessing acute kidney injury in critically ill patients who are considered for admission to critical care. Data sources Major electronic databases, conference abstracts and ongoing studies were searched up to June 2019, with no date restrictions. MEDLINE, EMBASE, Health Technology Assessment Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science, World Health Organization Global Index Medicus, EU Clinical Trials Register, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched. Review methods A systematic review and meta-analysis were conducted to evaluate the performance of novel biomarkers for the detection of acute kidney injury and prediction of other relevant clinical outcomes. Random-effects models were adopted to combine evidence. A decision tree was developed to evaluate costs and quality-adjusted life-years accrued as a result of changes in short-term outcomes (up to 90 days), and a Markov model was used to extrapolate results over a lifetime time horizon. Results A total of 56 studies (17,967 participants), mainly prospective cohort studies, were selected for inclusion. No studies addressing the clinical impact of the use of biomarkers on patient outcomes, compared with standard care, were identified. The main sources of bias across studies were a lack of information on blinding and the optimal threshold for NGAL. For prediction studies, the reporting of statistical details was limited. Although the meta-analyses results showed the potential ability of these biomarkers to detect and predict acute kidney injury, there were limited data to establish any causal link with longer-term health outcomes and there were considerable clinical differences across studies. Cost-effectiveness results were highly uncertain, largely speculative and should be interpreted with caution in the light of the limited evidence base. To illustrate the current uncertainty, 15 scenario analyses were undertaken. Incremental quality-adjusted life-years were very low across all scenarios, ranging from positive to negative increments. Incremental costs were also small, in general, with some scenarios generating cost savings with tests dominant over standard care (cost savings with quality-adjusted life-year gains). However, other scenarios generated results whereby the candidate tests were more costly with fewer quality-adjusted life-years, and were thus dominated by standard care. Therefore, it was not possible to determine a plausible base-case incremental cost-effectiveness ratio for the tests, compared with standard care. Limitations Clinical effectiveness and cost-effectiveness results were hampered by the considerable heterogeneity across identified studies. Economic model predictions should also be interpreted cautiously because of the unknown impact of NGAL-guided treatment, and uncertain causal links between changes in acute kidney injury status and changes in health outcomes. Conclusions Current evidence is insufficient to make a full appraisal of the role and economic value of these biomarkers and to determine whether or not they provide cost-effective improvements in the clinical outcomes of acute kidney injury patients. Future work Future studies should evaluate the targeted use of biomarkers among specific patient populations and the clinical impact of their routine use on patient outcomes and management. Study registration This study is registered as PROSPERO CRD42019147039. Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 26, No. 7. See the NIHR Journals Library website for further project information.

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Section: Diagnostic Test Costsmentioning

confidence: 99%

Section: Acute (Decision Tree) Phase Of the Modelmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Biomarkers for assessing acute kidney injury for people who are being considered for admission to critical care: a systematic review and cost-effectiveness analysis

Brazzelli

Aucott

Aceves‐Martins

et al. 2022

Health Technol Assess

Self Cite

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“…The use of novel AKI biomarkers may aid hospital systems in implementing management strategies, such as care bundles [ 36 , 37 ] to prevent AKI or its progression to a higher stage, thereby improving outcomes and reducing healthcare costs. Although cost-effectiveness evidence for different biomarker tests for early detection of AKI is sparse [ [123] , [124] , [125] ], existing evidence suggests that these may be cost effective when considered along with the standard of care (i.e., serum creatinine). Notably, the higher the prevalence of AKI, the more likely the tests are to be cost-effective.…”

Section: Cost-effectiveness Of Using Biomarkers To Detect Akimentioning

confidence: 99%