Cost-effectiveness analysis of acute kidney injury biomarkers in pediatric cardiac surgery

Abstract

IntroductionAcute kidney injury (AKI) is significant problem in children with congenital heart disease (CHD) who undergo cardiac surgery. The economic impact of a biomarker-based diagnostic strategy for AKI in pediatric populations undergoing CHD surgery is unknown. The aim of this study was to perform the cost effectiveness analysis of using serum cystatin C (sCysC), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine liver fatty acid-binding protein (uL-FABP) for the diagnosis of AKI in children after cardiac surgery compared with current diagnostic method (monitoring of serum creatinine (sCr) level).Materials and methodsWe developed a decision analytical model to estimate incremental cost-effectiveness of different biomarker-based diagnostic strategies compared to current diagnostic strategy. The Markov model was created to compare the lifetime cost associated with using of sCysC, uNGAL, uL-FABP with monitoring of sCr level for the diagnosis of AKI. The utility measurement included in the analysis was quality-adjusted life years (QALY). The results of the analysis are presented as the incremental cost-effectiveness ratio (ICER).ResultsAnalysed biomarker-based diagnostic strategies for AKI were cost-effective compared to current diagnostic method. However, uNGAL and sCys C strategies yielded higher costs and lower effectiveness compared to uL-FABP strategy. uL-FABP added 1.43 QALY compared to current diagnostic method at an additional cost of $8521.87 per patient. Therefore, ICER for uL-FABP compared to sCr was $5959.35/QALY.ConclusionsOur results suggest that the use of uL-FABP would represent cost effective strategy for early diagnosis of AKI in children after cardiac surgery.

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“…52 Petrovic et al estimated the prevalence of CKD in CHD patients based on the calculation of eGFR by SCR. 53 Blood Urea Nitrogen (BUN)…”

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“…With a decision‐analytic Markov model, Petrovic et al. suggested that urinary liver‐type FABP yields both higher effectiveness and lower cost than neutrophil gelatinase–associated lipocalin (NGAL) and serum cystatin C in diagnosing acute kidney injury in pediatric cardiac surgery . Using a similar model, Critselis and colleagues reached the conclusion that an annual CKD273 classifier–based approach is more effectively, albeit costlier, in screening chronic kidney disease progression in comparison with urinary albumin excretion test …”

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