Economic evaluation of intravenous iodinated contrast media in Italy.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
SIHS Health Economics Consulting.
Sergio
S
Iannazzo
IMS Health.
Stijn
S
Vandekerckhove
IMS Health.
Maria
M
De Francesco
San Bortolo Hospital.
Akash
A
Nayak
San Bortolo Hospital.
Claudio
C
Ronco
Ca'Foncello Hospital.
Giovanni
G
Morana
S. Antonio Abate Hospital.
Massimo
M
Valentino
D000368:Aged; D003257:Consumer Product Safety; D003287:Contrast Media / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007558:Italy; D007674:Kidney Diseases / Q000139:chemically induced* / Q000401:mortality; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D009994:Osmolar Concentration; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000009:adverse effects / Q000191:economics*
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol