title: Management of acute kidney injury in the intensive care unit: a cost-effectiveness analysis of daily vs alternate-day hemodialysis.
abstract: BACKGROUND
  Although evidence suggests that a higher hemodialysis dose and/or frequency may be associated with improved outcomes, the cost-effectiveness of a daily hemodialysis strategy for critically ill patients with acute kidney injury (AKI) is unknown.
  
  
  METHODS
  We developed a Markov model of the cost, quality of life, survival, and incremental cost-effectiveness of daily hemodialysis, compared with alternate-day hemodialysis, for patients with AKI in the intensive care unit (ICU). We employed a societal perspective with a lifetime analytic time horizon. We modeled the efficacy of daily hemodialysis as a reduction in the relative risk of death on the basis of data reported in the 2004 clinical trial published by Schiffl et al. We performed 1- and 2-way sensitivity analyses across cost, efficacy, and utility input variables. The main outcome measure was cost per quality-adjusted life-year (QALY).
  
  
  RESULTS
  In the base case for a 60-year-old man, daily hemodialysis was projected to add 2.14 QALYs and $10,924 in cost. We found that the cost-effectiveness of daily hemodialysis compared with alternate-day hemodialysis was $5084 per QALY gained. The incremental cost-effectiveness ratio became less favorable (>$50,000 per QALY gained) when the maintenance hemodialysis rate of the daily hemodialysis group was varied to more than 27% and when the difference in 14-day postdischarge mortality between the alternatives was varied to less than 0.5%.
  
  
  CONCLUSIONS
  Daily hemodialysis is a cost-effective strategy compared with alternate-day hemodialysis for patients with severe AKI in the ICU.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, 780 Welch Rd, Ste 106, Palo Alto, California 94304, USA. desai_amar@hotmail.com
authors.forename: Amar A
authors.initials: AA
authors.lastname: Desai
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Baras
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Berk
authors.forename: Aya
authors.initials: A
authors.lastname: Nakajima
authors.forename: Alan M
authors.initials: AM
authors.lastname: Garber
authors.forename: Douglas
authors.initials: D
authors.lastname: Owens
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics*; D015996:Survival Rate