Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Clin Ther. 2011 Nov;33(11):1713-25. doi: 10.1016/j.clinthera.2011.09.014. Epub 2011 Nov 8.
Acute kidney injury (AKI) is common after cardiac surgery, and expeditious recognition with specific biomarkers may help improve outcome.
Because the economic impact of a biomarker-based diagnostic strategy is unknown, we assessed the cost-effectiveness of using urinary neutrophil gelatinase-associated lipocalin (NGAL) for the diagnosis of AKI after cardiac surgery compared with current diagnostic methods.
A decision analysis model was developed using the societal perspective to evaluate the cost-effectiveness of NGAL. Cost per quality-adjusted life-year (QALY) was determined for NGAL and standard strategies. The base case was a 67-year-old male patient undergoing coronary artery bypass graft surgery in the United Kingdom. Multiple sensitivity analyses were performed to determine how cost-effectiveness would vary with changes in the underlying clinical and economic variables.
The base case yielded expected costs of £4244 and 11.86 QALYs for the NGAL strategy compared with £4672 and 11.79 QALYs for the standard therapy. The cost-effectiveness ratio for the NGAL strategy was £358/QALY compared with £396/QALY for the standard regimen. Cost-effectiveness increased as the treatment effect-defined as the ability to prevent progression of established AKI (kidney injury or failure)-for the therapy triggered by an elevated NGAL level rose. Sensitivity analysis demonstrated that the model was most responsive to the probability of developing AKI and least sensitive to the test cost for NGAL. Probabilistic sensitivity analysis supported the NGAL strategy as the most cost-effective option. Because this study was a decision analysis model incorporating a nonspecific treatment for AKI (as opposed to an observational study or controlled trial), model structural assumptions may therefore have underestimated mortality and the likelihood of developing AKI, although these were tested in multiple sensitivity analyses. Indirect costs were also not explicitly factored.
The use of urinary NGAL after cardiac surgery appears to be cost-effective in the early diagnosis of AKI.
心脏手术后常发生急性肾损伤（AKI），通过特定的生物标志物快速识别可能有助于改善预后。
由于基于生物标志物的诊断策略的经济影响尚不清楚，我们评估了与当前诊断方法相比，使用尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）诊断心脏手术后 AKI 的成本效益。
使用社会视角开发了决策分析模型来评估 NGAL 的成本效益。确定了 NGAL 和标准策略的每质量调整生命年（QALY）的成本。基础病例是一位 67 岁男性患者，在英国接受冠状动脉旁路移植手术。进行了多次敏感性分析，以确定成本效益会如何随临床和经济变量的变化而变化。
基础病例中，NGAL 策略的预期成本为 4244 英镑，QALY 为 11.86，而标准治疗的成本为 4672 英镑，QALY 为 11.79。与标准方案相比，NGAL 策略的成本效益比为 358 英镑/QALY。随着治疗效果的提高，即通过升高的 NGAL 水平触发的治疗预防已确立的 AKI（肾损伤或衰竭）进展的能力提高，成本效益也随之增加。敏感性分析表明，该模型对 AKI 发生的概率最敏感，对 NGAL 检测成本最不敏感。概率敏感性分析支持 NGAL 策略是最具成本效益的选择。由于本研究是一项纳入 AKI 非特异性治疗的决策分析模型（而不是观察性研究或对照试验），因此模型结构假设可能低估了死亡率和 AKI 发生的可能性，尽管在多次敏感性分析中对此进行了测试。间接成本也没有明确计入。
心脏手术后使用尿 NGAL 似乎可以在早期诊断 AKI 方面具有成本效益。
