Randomized Controlled Trial Evidence of Cost-Effectiveness of a Multifaceted AKI Intervention Approach

Abstract

Introduction: Acute kidney injury (AKI) is associated with increased health care utilization and higher costs. The Tackling AKI study was a multicenter, pragmatic, stepped-wedge cluster randomized trial that demonstrated a reduced hospital length of stay after implementation of a multifaceted AKI intervention (e-alerts, care bundle, and an education program). We tested whether this would result in cost savings.

Methods: A decision-analytic tree model from the payer perspective (National Health Service in the United Kingdom) was generated on which cost-effectiveness analyses were performed using a probabilistic sensitivity analysis, accounting only for direct medical costs. Clinical data from the Tackling AKI study were used as inputs and economic and utility data derived from relevant published literature.

Results: A total of 24,059 AKI episodes occurred during the study period, and in 18,887 admissions the patient was discharged alive. When all AKI stages were considered together, the cost per AKI admission was £5065 in the control arm and £4333 in the intervention arm, representing an incremental cost saving of £732 per admission with the intervention. Similar results were obtained when AKI stages were included as separate variables. Costs per quality-adjusted life year were £61,194 in the control group and £51,161 in the intervention group. At a willingness to pay threshold of £20,000 per quality-adjusted life year, the probability of the intervention being cost-effective compared with standard care was 90%.

Conclusion: An organizational level approach to improve standards of AKI care reduces the cost of hospital admissions and is cost effective within the National Health Service in the United Kingdom.

Keywords: AKI; care bundle; e-alert; health economics; length of stay.

Graphical abstract

Figure 1

The decision-analytic tree model. AKI, acute kidney injury; ICU, intensive care unit; LoS, length of stay; QALY, quality-adjusted life year.

Figure 2

Cost-effectiveness scatterplot showing the 5000 iterations from the probabilistic sensitivity analysis for incremental costs (£) and incremental quality-adjusted life years (QALYs).

Figure 3

Cost effectiveness acceptability curve, representing the probability of the intervention of being cost effective for every willingness to pay (WTP) value up to a maximum WTP of £50,000. The WTP threshold was taken as £20,000 per quality-adjusted life year.