Continuous renal replacement therapy in adult patients with acute renal failure: systematic review and economic evaluation
Tonelli M, Manns B, Wiebe N, Shrive F, Pannu N, Doig C, Klarenbach S
Record ID 32007000540
English
Authors' objectives:
"Our objectives were to conduct a systematic review of the efficacy and harm of CRRT and IHD, and to conduct an economic evaluation and budget impact analysis comparing these strategies in critically ill adult patients with ARF." (executive summary)
Authors' results and conclusions:
The systematic review did not reveal statistically significant differences in clinical outcomes between IHD and CRRT. Economic models suggested that IHD could be cost-saving or lead to additional downstream costs. Cost effectiveness is influenced by small differences inpatient survival and need for long-term dialysis.
Authors' recommendations:
Implications for Decision Making
The benefit from CRRT is yet to be proven. Compared to IHD, observed differences in clinical outcomes after CRRT (dialysis dependence at study end, number of hospitalization days) were not statistically significant, but had wide confidence intervals, suggesting that meaningful clinical differences could exist. Available evidence suggests similar rates of mortality between modalities.
IHD reduces acute-care costs. Given current CRRT usage rates of 26% to 68%, selectively funding IHD when either technology is appropriate would save 2.1 million to 6.1 million in acute-care costs. If no improvements in clinical outcomes are obtained with CRRT, its use leads to equal QALYs and an additional cost of 3,679 compared with IHD. If IHD leads to reduced mortality, it produces 0.07QALYs and additional costs of 8,541 perpatient largely due to the additional downstream costs of more long-term dialysis. (all figures Canadian dollars)
Decisions about optimal therapy should be revisited as more information becomes available. If future studies suggest that CRRT leads to better clinical outcomes, especially a reduced risk of dialysis dependence among survivors, the cost-effectiveness of CRRT should be revisited.
Authors' methods:
Systematic review
Details
Project Status:
Completed
Year Published:
2007
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
MeSH Terms
- Adult
- Renal Replacement Therapy
Contact
Organisation Name:
Canadian Agency for Drugs and Technologies in Health
Contact Address:
600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
Contact Name:
requests@cadth.ca
Contact Email:
requests@cadth.ca
Copyright:
Canadian Agency for Drugs and Technologies in Health (CADTH)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.