DyeVert™ PLUS EZ System for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Diagnostic Coronary Angiography and/or Percutaneous Coronary Intervention: A UK-Based Cost–Utility Analysis

Abstract

Background Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert™ PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall volume of contrast media injected and aortic reflux, and potentially improving long-term health outcomes. Objectives To assess the long-term costs and health outcomes associated with the introduction of the DyeVert™ PLUS EZ system into the UK health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3-4 undergoing diagnostic coronary angiography (DAG) and/or percutaneous coronary intervention (PCI), and to compare these costs and outcomes with those of the current practice. Methods A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert™ in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were from the NHS and personal social services perspective and obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results. Results Base-case results indicate that the intervention leads to cost savings (− £435) and improved effectiveness (+ 0.028 QALYs) over the patient's lifetime compared with current practice. Output from the probabilistic analysis points to a high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall longterm cost saving for the NHS associated with the introduction of the DyeVert™ PLUS EZ system is over £19.7 million for each annual cohort of patients. The cost savings are mainly driven by a lower risk of subsequent diseases and their associated costs. Conclusions The introduction of the DyeVert™ PLUS EZ system has the potential to reduce costs for the health care service and yield improved clinical outcomes for patients with CKD stage 3-4 undergoing angiographic procedures.

Contrast-induced acute kidney injury and its contemporary prevention

“…As a result, the number needed to treat for CI-AKI prevention is 20, preserving adequate image quality in 98% patients ( 141 ). Further information from a UK-based Cost-utility Analysis revealed that DyeVert™ results in cost savings as well as improved effectiveness over the course of a patient’s lifetime (−£435 and +0.028 QALYs) ( 142 ). The ongoing Renal Insufficiency Following Contrast Media Administration Trial IV (REMEDIAL IV) seeks to determine whether the DyeVert™ system is effective in lowering the rate of CI-AKI in patients with acute coronary syndrome undergoing urgent/immediate (within 2 h) invasive diagnostic or interventional cardiovascular procedures.…”

Cost‐effectiveness analysis of dyevert™ Power XT in patients with chronic kidney disease undergoing percutaneous coronary intervention procedures in Spain

“…Currently, to our knowledge, there is no published economic evaluation in the Spanish context comparing Dyevert™ Power XT versus current standard practice in patients with CKD stages 3b‐4 undergoing PCI; however, a previous work evaluated the effectiveness of Dyevert™ in the UK setting 35 . The analysis here performed in Spain, used a similar approach, based on the same decision tree model and with slight differences on the Markov structure than the UK study.…”

“…Another possible limitation is related to the use of data extracted from the literature of studies conducted in other countries. The utility values used in the present model derived from studies on different settings and countries 32–35 . No study specifically referring to a Spanish population with CKD was found by authors, so international values were applied, which were validated by the panel of experts to ensure that these values are representative of the Spanish population with CKD.…”

DyeVert Contrast Reduction System Use in Patients Undergoing Coronary and/or Peripheral Angiography: A Systematic Literature Review and Meta-Analysis

“…Briguori et al was the first report of a procedure-based CA-AKI prevention strategy resulting in significant CA-AKI reduction as well as a significantly shorter length of stay of about 2 days ( 30 ). Given the high cost of CA-AKI events ( 6 ), the overall economic value of the DyeVert System may be derived from CA-AKI avoidance based on recent hospital budget impact evaluations ( 32 , 40 , 41 ) and a modeling study ( 44 ).…”