Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury

Abstract Background Early and accurate acute kidney injury (AKI) detection may improve patient outcomes and reduce health service costs. This study evaluates the diagnostic accuracy and cost-effectiveness of NephroCheck and NGAL (urine and plasma) biomarker tests used alongside standard care, compar...

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Autores principales:	Elisabet Jacobsen, Simon Sawhney, Miriam Brazzelli, Lorna Aucott, Graham Scotland, Magaly Aceves-Martins, Clare Robertson, Mari Imamura, Amudha Poobalan, Paul Manson, Callum Kaye, Dwayne Boyers
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Acute kidney injury Critical care Cost-effectiveness Diagnostic accuracy Economic evaluation Markov model Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/09fd6089cb9e43bfbbbf2b10254d79ac
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spelling	oai:doaj.org-article:09fd6089cb9e43bfbbbf2b10254d79ac2021-12-05T12:26:02ZCost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury10.1186/s12882-021-02610-91471-2369https://doaj.org/article/09fd6089cb9e43bfbbbf2b10254d79ac2021-12-01T00:00:00Zhttps://doi.org/10.1186/s12882-021-02610-9https://doaj.org/toc/1471-2369Abstract Background Early and accurate acute kidney injury (AKI) detection may improve patient outcomes and reduce health service costs. This study evaluates the diagnostic accuracy and cost-effectiveness of NephroCheck and NGAL (urine and plasma) biomarker tests used alongside standard care, compared with standard care to detect AKI in hospitalised UK adults. Methods A 90-day decision tree and lifetime Markov cohort model predicted costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) from a UK NHS perspective. Test accuracy was informed by a meta-analysis of diagnostic accuracy studies. Clinical trial and observational data informed the link between AKI and health outcomes, health state probabilities, costs and utilities. Value of information (VOI) analysis informed future research priorities. Results Under base case assumptions, the biomarker tests were not cost-effective with ICERs of £105,965 (NephroCheck), £539,041 (NGAL urine BioPorto), £633,846 (NGAL plasma BioPorto) and £725,061 (NGAL urine ARCHITECT) per QALY gained compared to standard care. Results were uncertain, due to limited trial data, with probabilities of cost-effectiveness at £20,000 per QALY ranging from 0 to 99% and 0 to 56% for NephroCheck and NGAL tests respectively. The expected value of perfect information (EVPI) was £66 M, which demonstrated that additional research to resolve decision uncertainty is worthwhile. Conclusions Current evidence is inadequate to support the cost-effectiveness of general use of biomarker tests. Future research evaluating the clinical and cost-effectiveness of test guided implementation of protective care bundles is necessary. Improving the evidence base around the impact of tests on AKI staging, and of AKI staging on clinical outcomes would have the greatest impact on reducing decision uncertainty.Elisabet JacobsenSimon SawhneyMiriam BrazzelliLorna AucottGraham ScotlandMagaly Aceves-MartinsClare RobertsonMari ImamuraAmudha PoobalanPaul MansonCallum KayeDwayne BoyersBMCarticleAcute kidney injuryCritical careCost-effectivenessDiagnostic accuracyEconomic evaluationMarkov modelDiseases of the genitourinary system. UrologyRC870-923ENBMC Nephrology, Vol 22, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Acute kidney injury Critical care Cost-effectiveness Diagnostic accuracy Economic evaluation Markov model Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Acute kidney injury Critical care Cost-effectiveness Diagnostic accuracy Economic evaluation Markov model Diseases of the genitourinary system. Urology RC870-923 Elisabet Jacobsen Simon Sawhney Miriam Brazzelli Lorna Aucott Graham Scotland Magaly Aceves-Martins Clare Robertson Mari Imamura Amudha Poobalan Paul Manson Callum Kaye Dwayne Boyers Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury
description	Abstract Background Early and accurate acute kidney injury (AKI) detection may improve patient outcomes and reduce health service costs. This study evaluates the diagnostic accuracy and cost-effectiveness of NephroCheck and NGAL (urine and plasma) biomarker tests used alongside standard care, compared with standard care to detect AKI in hospitalised UK adults. Methods A 90-day decision tree and lifetime Markov cohort model predicted costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) from a UK NHS perspective. Test accuracy was informed by a meta-analysis of diagnostic accuracy studies. Clinical trial and observational data informed the link between AKI and health outcomes, health state probabilities, costs and utilities. Value of information (VOI) analysis informed future research priorities. Results Under base case assumptions, the biomarker tests were not cost-effective with ICERs of £105,965 (NephroCheck), £539,041 (NGAL urine BioPorto), £633,846 (NGAL plasma BioPorto) and £725,061 (NGAL urine ARCHITECT) per QALY gained compared to standard care. Results were uncertain, due to limited trial data, with probabilities of cost-effectiveness at £20,000 per QALY ranging from 0 to 99% and 0 to 56% for NephroCheck and NGAL tests respectively. The expected value of perfect information (EVPI) was £66 M, which demonstrated that additional research to resolve decision uncertainty is worthwhile. Conclusions Current evidence is inadequate to support the cost-effectiveness of general use of biomarker tests. Future research evaluating the clinical and cost-effectiveness of test guided implementation of protective care bundles is necessary. Improving the evidence base around the impact of tests on AKI staging, and of AKI staging on clinical outcomes would have the greatest impact on reducing decision uncertainty.
format	article
author	Elisabet Jacobsen Simon Sawhney Miriam Brazzelli Lorna Aucott Graham Scotland Magaly Aceves-Martins Clare Robertson Mari Imamura Amudha Poobalan Paul Manson Callum Kaye Dwayne Boyers
author_facet	Elisabet Jacobsen Simon Sawhney Miriam Brazzelli Lorna Aucott Graham Scotland Magaly Aceves-Martins Clare Robertson Mari Imamura Amudha Poobalan Paul Manson Callum Kaye Dwayne Boyers
author_sort	Elisabet Jacobsen
title	Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury
title_short	Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury
title_full	Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury
title_fullStr	Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury
title_full_unstemmed	Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury
title_sort	cost-effectiveness and value of information analysis of nephrocheck and ngal tests compared to standard care for the diagnosis of acute kidney injury
publisher	BMC
publishDate	2021
url	https://doaj.org/article/09fd6089cb9e43bfbbbf2b10254d79ac
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Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury

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