Dataset Information

A Prospective Micro-costing Pilot Study of the Health Economic Costs of Acute Kidney Injury.

ABSTRACT:

Introduction

Acute kidney injury (AKI) prevalence in the UK is estimated to be approximately 20% of all emergency admissions. Complications of AKI have a huge impact on health care costs. Most studies that have researched the economic costs of AKI have used macro-level costing using national tariffs and applying this to hospital episode statistics.

Methods

The Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) study was a pilot study that tested the provision of early specialist advice to improve outcomes for patients with AKI. As part of this prospective study, we undertook a health economics substudy that involved micro-costing to help more accurately define the total cost per patient.

Results

We found that the total cost of providing an AKI alert system and an outreach service (intervention group) was lower than current practice (control group) for patients with AKI. Overall, an episode of AKI that required inpatient care costs approximately £5000 over 12 months, which is somewhat higher than previous UK estimates. Although it was feasible to collect the required complex dataset needed to conduct a health economics analysis of an outreach service, significant amounts of time and resources needed to be dedicated to this endeavor.

Conclusion

We showed that it is possible to demonstrate a clearer, more detailed picture of the prolonged economic costs of AKI for a health care system, as part of a substudy of a larger trial. A larger scale, randomized controlled trial of AKI outreach is needed, with a prospective full economic evaluation conducted alongside the trial.

SUBMITTER: Mistry H

PROVIDER: S-EPMC6224786 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The significance of minimal increases in serum creatinine below the levels indicative of the acute kidney injury (AKI) stage is not well established. We aimed to investigate the influence of pre-stage AKI (pre-AKI) on clinical outcomes. We enrolled a total of 21,261 patients who were admitted to the Seoul National University Bundang Hospital from January 1, 2013 to December 31, 2013. Pre-AKI was defined as a 25-50% increase in peak serum creatinine levels from baseline levels during the hospital stay. In total, 5.4% of the patients had pre-AKI during admission. The patients with pre-AKI were predominantly female (55.0%) and had a lower body weight and lower baseline levels of serum creatinine (0.63 ± 0.18 mg/dl) than the patients with AKI and the patients without AKI (P < 0.001). The patients with pre-AKI had a higher prevalence of diabetes mellitus (25.1%) and malignancy (32.6%). The adjusted hazard ratio of in-hospital mortality for pre-AKI was 2.112 [95% confidence interval (CI), 1.143 to 3.903]. In addition, patients with pre-AKI had an increased length of stay (7.7 ± 9.7 days in patients without AKI, 11.4 ± 11.4 days in patients with pre-AKI, P < 0.001) and increased medical costs (4,061 ± 4,318 USD in patients without AKI, 4,966 ± 5,099 USD in patients with pre-AKI, P < 0.001) during admission. The adjusted hazard ratio of all-cause mortality for pre-AKI during the follow-up period of 2.0 ± 0.6 years was 1.473 (95% CI, 1.228 to 1.684). Although the adjusted hazard ratio of pre-AKI for overall mortality was not significant among the patients admitted to the surgery department or who underwent surgery, pre-AKI was significantly associated with mortality among the non-surgical patients (adjusted HR 1.542 [95% CI, 1.330 to 1.787]) and the patients admitted to the medical department (adjusted HR 1.384 [95% CI, 1.153 to 1.662]). Pre-AKI is associated with increased mortality, longer hospital stay, and increased medical costs during admission. More attention should be paid to the clinical significance of pre-AKI.