Iannazzo Sergio, Vandekerckhove Stijn, De Francesco Maria, Nayak Akash, Ronco Claudio, Morana Giovanni, Valentino Massimo
SIHS Health Economics Consulting.
IMS Health.
Int J Technol Assess Health Care. 2014 Jan;30(1):69-77. doi: 10.1017/S0266462313000706. Epub 2014 Jan 31.
Contrast-induced acute kidney injury (CI-AKI) is defined as a deterioration in renal function after administration of radiologic iodinated contrast media (CM). Iodixanol, showed a lower CI-AKI incidence than low-osmolar contrast media (LOCM). A cost-effectiveness analysis was performed comparing iodixanol and LOCM in intravenous (IV) setting in Italy.
A Markov model was developed. Patients moved across four health states: CI-AKI free, CI-AKI, myocardial infarction, and death. The simulation horizon was lifetime with 1-month cycles. Costs and outcomes were discounted at 3.5 percent rate. CI-AKI incidence was considered from published literature across different definitions. Cost-effectiveness of iodixanol was assessed in terms of incremental cost per life-year gained. Net monetary benefit (NMB) was also calculated. Both deterministic and probabilistic sensitivity analyses were performed.
Base-case results showed an average survival increase of 0.51 life-years and a savings of €7.25 for iodixanol versus LOCM. The cost-effectiveness of iodixanol was confirmed when other scenarios were explored, such as varying CI-AKI definition, sub-populations with specified risk factors, CM hospital bids prices, and inclusion of adverse drug reactions of allergic nature. An NMB ranging between €6,007.25 and €30,007.25 was calculated.
Base-case results show that IV iodixanol is cost-effective compared with LOCM in the Italian clinical setting of a hospital computed tomography radiology practice. However, some caution is due, mainly linked to inherent limitations of the modeling technique and to the lack of agreement on CI-AKI incidence data in the clinical literature.
对比剂诱导的急性肾损伤（CI-AKI）被定义为在使用放射学碘化造影剂（CM）后肾功能的恶化。碘克沙醇显示出比低渗造影剂（LOCM）更低的CI-AKI发生率。在意大利进行了一项成本效益分析，比较静脉注射（IV）情况下碘克沙醇和LOCM。
建立了一个马尔可夫模型。患者在四种健康状态之间转换：无CI-AKI、CI-AKI、心肌梗死和死亡。模拟期为终身，以1个月为周期。成本和结果以3.5%的贴现率进行贴现。CI-AKI发生率参考了不同定义的已发表文献。通过每获得一个生命年的增量成本来评估碘克沙醇的成本效益。还计算了净货币效益（NMB）。进行了确定性和概率敏感性分析。
基础案例结果显示，与LOCM相比，碘克沙醇的平均生存期增加了0.51个生命年，节省了7.25欧元。当探索其他情景时，如改变CI-AKI定义、具有特定危险因素的亚人群、CM医院投标价格以及纳入过敏性药物不良反应时，碘克沙醇的成本效益得到了证实。计算出的NMB在6,007.25欧元至30,007.25欧元之间。
基础案例结果表明，在意大利医院计算机断层扫描放射学实践的临床环境中，静脉注射碘克沙醇与LOCM相比具有成本效益。然而，需要谨慎，主要是由于建模技术的固有局限性以及临床文献中关于CI-AKI发生率数据缺乏一致性。
