Swapnil Hiremath1, Ayub Akbari2, George A Wells3, Benjamin J W Chow4. 1. Department of Medicine (Nephrology) & Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr, Ottawa, ON, K1H7W9, Canada. shiremath@toh.on.ca. 2. Department of Medicine (Nephrology) & Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr, Ottawa, ON, K1H7W9, Canada. 3. Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada. 4. Department of Medicine (Cardiology) and Radiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Abstract
PURPOSE: Contrast-induced acute kidney injury is a prominent complication following cardiac catheterization, though the risk has progressively decreased in recent times with appropriate risk stratification and use of safer contrast agents. Despite data supporting further lowering of risk with the iso-osmolar agent, iodixanol, uptake has lagged, perhaps due to increased upfront cost of this agent. We undertook an economic analysis to estimate the cost-effectiveness of a strategy utilizing iodixanol compared to using a low-osmolar contrast agent. METHODS: We created a Markov model to evaluate the two strategies, and included a differential relative risk of contrast-induced acute kidney injury, based on a systematic review of the literature. Downstream clinical events, including need for dialysis and mortality, were modeled using data from existing published literature. A third-party payer perspective was utilized for the analysis and presentation of the primary economic analysis. RESULTS: The strategy of using iodixanol dominated in both the low-risk and high-risk base case analyses. However, the difference was quite small in the low-risk scenario (lifetime cost: C$678,034 vs. C$678,059 and life expectancy: 19.80 vs. 19.72 years). The difference was more marked (life expectancy 15.65 vs. 14.15 years and cost C$680,989 vs. C$682,023) in the high-risk case analysis. This was robust across most of the variables tested in sensitivity analyses. CONCLUSION: The use of iodixanol, compared with low-osmolar contrast agents, for cardiac catheterization, results in a small benefit clinical outcomes, and in a savings in direct healthcare costs. Overall, our analysis supports the use of iodixanol for cardiac catheterization, especially in patients at high risk of acute kidney injury.
PURPOSE: Contrast-induced acute kidney injury is a prominent complication following cardiac catheterization, though the risk has progressively decreased in recent times with appropriate risk stratification and use of safer contrast agents. Despite data supporting further lowering of risk with the iso-osmolar agent, iodixanol, uptake has lagged, perhaps due to increased upfront cost of this agent. We undertook an economic analysis to estimate the cost-effectiveness of a strategy utilizing iodixanol compared to using a low-osmolar contrast agent. METHODS: We created a Markov model to evaluate the two strategies, and included a differential relative risk of contrast-induced acute kidney injury, based on a systematic review of the literature. Downstream clinical events, including need for dialysis and mortality, were modeled using data from existing published literature. A third-party payer perspective was utilized for the analysis and presentation of the primary economic analysis. RESULTS: The strategy of using iodixanol dominated in both the low-risk and high-risk base case analyses. However, the difference was quite small in the low-risk scenario (lifetime cost: C$678,034 vs. C$678,059 and life expectancy: 19.80 vs. 19.72 years). The difference was more marked (life expectancy 15.65 vs. 14.15 years and cost C$680,989 vs. C$682,023) in the high-risk case analysis. This was robust across most of the variables tested in sensitivity analyses. CONCLUSION: The use of iodixanol, compared with low-osmolar contrast agents, for cardiac catheterization, results in a small benefit clinical outcomes, and in a savings in direct healthcare costs. Overall, our analysis supports the use of iodixanol for cardiac catheterization, especially in patients at high risk of acute kidney injury.
Authors: Sergio Iannazzo; Stijn Vandekerckhove; Maria De Francesco; Akash Nayak; Claudio Ronco; Giovanni Morana; Massimo Valentino Journal: Int J Technol Assess Health Care Date: 2014-01-31 Impact factor: 2.188
Authors: B J Barrett; P S Parfrey; H M Vavasour; J McDonald; G Kent; D Hefferton; F O'Dea; E Stone; R Reddy; P J McManamon Journal: Kidney Int Date: 1992-05 Impact factor: 10.612
Authors: Matthew T James; Susan M Samuel; Megan A Manning; Marcello Tonelli; William A Ghali; Peter Faris; Merril L Knudtson; Neesh Pannu; Brenda R Hemmelgarn Journal: Circ Cardiovasc Interv Date: 2013-01-15 Impact factor: 6.546
Authors: Peter Aspelin; Pierre Aubry; Sven-Göran Fransson; Ruth Strasser; Roland Willenbrock; Knut Joachim Berg Journal: N Engl J Med Date: 2003-02-06 Impact factor: 91.245
Authors: Roxana Mehran; Eve D Aymong; Eugenia Nikolsky; Zoran Lasic; Ioannis Iakovou; Martin Fahy; Gary S Mintz; Alexandra J Lansky; Jeffrey W Moses; Gregg W Stone; Martin B Leon; George Dangas Journal: J Am Coll Cardiol Date: 2004-10-06 Impact factor: 24.094