SpringerLink
Log in

Five-year cost-utility analysis of acute renal replacement therapy: a societal perspective

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

Assessment of the cost utility (CU) of acute renal replacement therapy (RRT) from a societal perspective during a 5-year follow-up.

Methods

This was a cross-sectional cohort study in a medical-surgical intensive care unit and an acute RRT unit of 410 consecutive patients treated with acute RRT in Helsinki University Hospital in 2000–2002. Five-year survival and health-related quality of life (HRQoL) were assessed and used to calculate quality-adjusted life years (QALYs) in two ways. They were first calculated for the 5-year follow-up period and, second, estimated for the expected lifetime. HRQoL was assessed by the EuroQol (EQ-5D) in 2003. The cost analysis included hospital costs during index hospitalization along with hospital and societal costs for the following 5 years. The CU ratio was determined as total costs divided by gained QALYs.

Results

Median survival time for all patients was 0.20 years and the EQ-5D index score was 0.68, 0.18 lower than that of the age- and gender-matched general population. All RRT-treated patients gained 0.10 QALYs/patient and hospital survivors 2.54 QALYs in 5 years. Overall the CU ratio was poor [5 year median 271,116 (29,782–2,177,581) €/QALY]. However, it was acceptable (less than 50,000 €/QALY) in patients who survived for more than a year and did not need chronic RRT. Cost utility decreased with increasing age exceeding 1.0 million €/QALY in the older groups.

Conclusions

In general, the CU ratio of acute RRT is poor. However, it is acceptable in patients with renal recovery who survive for more than 1 year.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Korkeila M, Ruokonen E, Takala J (2000) Costs of care, long-term prognosis and quality-of-life in patients requiring renal replacement therapy during intensive care. Intensive Care Med 26:1824–1831

    Article  PubMed  CAS  Google Scholar 

  2. Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, Godinez-Luna T, Svenson LW, Rosenal T (2005) Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care 9:R700–R709

    Article  PubMed  Google Scholar 

  3. Vaara ST, Pettilä V, Reinikainen M, Kaukonen K-M (2012) Population-based incidence, mortality and quality of life in critically ill patients treated with renal replacement therapy: a nationwide retrospective cohort study in Finnish ICUs. Crit Care 16:R13

    Article  PubMed  Google Scholar 

  4. Hsu CY, McCulloch CE, Fan D, Ordonez JD, Chertow GM, Go AS (2007) Community-based incidence of acute renal failure. Kidney Int 27:208–212

    Article  Google Scholar 

  5. Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committee (2007) Changes in the incidence and outcome for early acute kidney injury in a cohort of Australian intensive care units. Crit Care 11:R68

    Article  PubMed  Google Scholar 

  6. Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C (2006) An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 34:1913–1917

    Article  PubMed  Google Scholar 

  7. Groeneveld AB, Tran DD, van der Meulen J, Nauta JJ, Thijs LG (1991) Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome. Nephron 59:602–610

    Article  PubMed  CAS  Google Scholar 

  8. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ (1996) Acute renal failure in intensive care units—causes, outcome and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 24:192–198

    Article  PubMed  CAS  Google Scholar 

  9. De Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F (2000) Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 26:915–921

    Article  PubMed  Google Scholar 

  10. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818

    Article  PubMed  CAS  Google Scholar 

  11. Åhlström A, Kuitunen A, Peltonen S, Hynninen M, Tallgren M, Aaltonen J, Pettilä V (2006) Comparison of 2 acute renal failure severity scores to general scoring systems in the critically ill. Am J Kidney Dis 48:262–268

    Article  PubMed  Google Scholar 

  12. Ricci Z, Cruz D, Ronco C (2008) The RIFLE criteria and mortality in acute kidney injury. A systematic review. Kidney Int 73:538–546

    Article  PubMed  CAS  Google Scholar 

  13. Gopal I, Bhonagiri S, Ronco C, Bellomo R (1997) Out of hospital outcome and quality of life in survivors of combined acute multiple organ and renal failure treated with continuous venovenous hemofiltration/hemodiafiltration. Intensive Care Med 23:766–772

    Article  PubMed  CAS  Google Scholar 

  14. Åhlström A, Tallgren M, Peltonen S, Räsänen P, Pettilä V (2005) Survival and quality of life of patients requiring acute renal replacement therapy. Intensive Care Med 31:1222–1228

    Article  PubMed  Google Scholar 

  15. Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG (2000) Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 20:332

    Article  PubMed  CAS  Google Scholar 

  16. Morgera S, Kraft AK, Siebert G, Luft FC, Neumayer H–H (2002) Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis 40:275–279

    Article  PubMed  Google Scholar 

  17. Rimes-Stigare C, Awad A, Mårtensson J, Martling C-R, Bell M (2012) Long-term outcome after acute renal replacement therapy: a narrative review. Acta Anaesth Scand 56:138–146

    Article  PubMed  CAS  Google Scholar 

  18. Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM, Ray JG, University of Toronto Acute Kidney Injury Research Group (2009) Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 302:1179–1185

    Article  PubMed  CAS  Google Scholar 

  19. Delannoy B, Floccard B, Thiolliere F, Kaaki M, Badet M, Rosselli S, Ber CE, Saez A, Flandreau G, Guerin C (2009) Six-month outcome in acute kidney injury requiring renal replacement therapy in the ICU: a multicentre prospective study. Intensive Care Med 35:1907

    Article  PubMed  CAS  Google Scholar 

  20. Johansen KL, Smith MW, Unruh ML, Siroka AM, O’Connor TZ, Palevsky PM, VA/NIH Acute Renal Failure Trial Network (2010) Predictors of health utility among 60-day survivors of acute kidney injury in the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study. Clin J Am Soc Nephrol 5:1366–1372

    Article  PubMed  Google Scholar 

  21. Morsch C, Thome FS, Balbinotto A, Guimaraes JF, Barros EG (2011) Health-related quality of life and dialysis dependence in critically ill patient survivors of acute kidney injury. Ren Fail 33:949–956

    Article  PubMed  Google Scholar 

  22. Landoni G, Zangrillo A, Franco A, Aletti G, Roberti A, Calabrò MG, Slaviero G, Bignami E, Marino G (2006) Long-term outcome of patients who require renal replacement therapy after cardiac surgery. Eur J Anaesthesiol 23:17–22

    PubMed  CAS  Google Scholar 

  23. Hamel MB, Phillips RS, Davis RB, Desbiens N, Connors AF, Teno JM, Wenger N, Lynn J, Wu AW, Fulkerson W, Tsevat J, for the SUPPORT Investigators, (1997) Outcomes and cost-effectiveness of initiating and continuing aggressive care in seriously ill hospitalized adults. Ann Intern Med 127:195–202

    PubMed  CAS  Google Scholar 

  24. Desai A, Baras J, Berk BB, Nakajima A, Garber A, Owens D, Chertow G (2008) Management of acute kidney injury in the intensive care unit. A cost-effectiveness analysis of daily vs alternate-day hemodialysis. Arch Intern Med 168:1761–1767

    Article  PubMed  Google Scholar 

  25. Brooks R, with the EuroQol Group (1996) EuroQol: the current state of play. Health Policy 37:53–72

    Article  PubMed  CAS  Google Scholar 

  26. Bagshaw SM, Lapinsky S, Dial S, Arabi Y, Dodek P, Wood G, Ellis P, Guzman J, Marshall J, Parrillo JE, Skrobik Y, Kumar A (2009) Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Med 35:871–881

    Article  PubMed  Google Scholar 

  27. Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettilä V (2006) Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg 81:542–546

    Article  PubMed  Google Scholar 

  28. Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA (2008) Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol Dial Transpl 23:1970–1974

    Article  Google Scholar 

  29. Luckraz H, Gravenor MB, George R, Taylor S, Williams A, Ashraf S, Argano V, Youhana A (2005) Long and short-term outcomes in patients requiring continuous renal replacement therapy post cardiopulmonary bypass. Eur J Cardiothorac Surg 27:906–909

    Article  PubMed  Google Scholar 

  30. Coxa SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR (2009) Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 53:961–973

    Article  Google Scholar 

  31. Van Berendoncks AM, Elseviers MM, Lins RL, for the SHARF Study Group (2010) Outcome of acute kidney injury with different treatment options: long-term follow-up. Clin J Am Soc Nephrol 5:1755–1762

    Article  PubMed  Google Scholar 

  32. Cox CE, Carson SS, Govert JA, Chelluri L, Sanders GD (2007) An economic evaluation of prolonged mechanical ventilation. Crit Care Med 35:1918–1927

    Article  PubMed  Google Scholar 

  33. Srisawat N, Lawsin L, Uchino S, Bellomo R, Kellum JA, BEST Kidney Investigators (2010) Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Study. Crit Care 14:R46

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Prof. Seppo Sarna for his help in the statistical analysis.

Author information

Authors and Affiliations

  1. Intensive Care Unit, Division of Anaesthesiology and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland

    Annika Laukkanen, Linda Emaus, Ville Pettilä & Kirsi-Maija Kaukonen

Authors
  1. Annika Laukkanen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda Emaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ville Pettilä
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kirsi-Maija Kaukonen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Annika Laukkanen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laukkanen, A., Emaus, L., Pettilä, V. et al. Five-year cost-utility analysis of acute renal replacement therapy: a societal perspective. Intensive Care Med 39, 406–413 (2013). https://doi.org/10.1007/s00134-012-2760-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-012-2760-4

Keywords

Search

Navigation