Treatment of acute kidney injury with continuous renal replacement therapy: does the protection of renal function really turns the modality cost-effective?

Abstract

Objectives: To assess the cost-effectiveness of continuous versus intermittent renal replacement therapy related to dialysis dependence under the perspective of the Brazilian Supplementary System in two time horizons: 10 years and 20 years (lifetime). Methods: Cost-effectiveness through a decision model based on a Markov model, applying clinical data on dialysis dependence and direct medical costs under the perspective of Brazilian health insurance plans. Health outcomes considered were: life years free of dialysis, quality adjusted life years and percentage of patients under complete remission after hospital discharge. Results: The continuous treatment has shown to be more effective and less costly than the intermittent modality in both time horizons evaluated. Additionally a reduction of 57.8% in the relative risk for patients initially treated with continuous therapy to beco[1]me chronic patients was observed, when compared to the intermittent therapy. Sensitivity analysis performed attested the robustness of the model, evidencing that the results remain favorable for the continuous modality and keeping the cost savings observed in the base case. Conclusions: The continuous renal replacement therapy can be associated with potential preservation of renal function in critical patients. Additionally, the choice of dialysis modality in such cases can bring substantial cost savings in long term, as dialysis dependence has a chronic pattern that can be extremely burdensome for health systems.