title: Cost-effectiveness analysis of acute kidney injury biomarkers in pediatric cardiac surgery.
abstract: BACKGROUND
  Acute kidney injury (AKI) is significant problem in children with congenital heart disease (CHD) who undergo cardiac surgery. The economic impact of a biomarker-based diagnostic strategy for AKI in pediatric populations undergoing CHD surgery is unknown. The aim of this study was to perform the cost effectiveness analysis of using serum cystatin C (sCysC), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine liver fatty acid-binding protein (uL-FABP) for the diagnosis of AKI in children after cardiac surgery compared with current diagnostic method (monitoring of serum creatinine (sCr) level).
  
  
  METHODS
  We developed a decision analytical model to estimate incremental cost-effectiveness of different biomarker-based diagnostic strategies compared to current diagnostic strategy. The Markov model was created to compare the lifetime cost associated with using of sCysC, uNGAL, uL-FABP with monitoring of sCr level for the diagnosis of AKI. The utility measurement included in the analysis was quality-adjusted life years (QALY). The results of the analysis are presented as the incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Analysed biomarker-based diagnostic strategies for AKI were cost-effective compared to current diagnostic method. However, uNGAL and sCys C strategies yielded higher costs and lower effectiveness compared to uL-FABP strategy. uL-FABP added 1.43 QALY compared to current diagnostic method at an additional cost of $8521.87 per patient. Therefore, ICER for uL-FABP compared to sCr was $5959.35/QALY.
  
  
  CONCLUSIONS
  Our results suggest that the use of uL-FABP would represent cost effective strategy for early diagnosis of AKI in children after cardiac surgery.
authors.affiliation: Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Stanislava
authors.initials: S
authors.lastname: Petrovic
authors.affiliation: Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Bogavac-Stanojevic
authors.affiliation: Department of Social Pharmacy and Pharmacy Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Dragana
authors.initials: D
authors.lastname: Lakic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia ; Department of Nephrology, University Children's Hospital, Belgrade, Serbia.
authors.forename: Amira
authors.initials: A
authors.lastname: Peco-Antic
authors.affiliation: Department of Cardio-surgery, University Children's Hospital, Belgrade, Serbia.
authors.forename: Irena
authors.initials: I
authors.lastname: Vulicevic
authors.affiliation: Department of Nephrology, University Children's Hospital, Belgrade, Serbia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Ivanisevic
authors.affiliation: Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Kotur-Stevuljevic
authors.affiliation: Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Zorana
authors.initials: Z
authors.lastname: Jelic-Ivanovic
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000293:Adolescent; D015415:Biomarkers / Q000097:blood / Q000652:urine; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D015891:Cystatins / Q000097:blood; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery / Q000652:urine; D006801:Humans; D007223:Infant; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D018803:Models, Economic; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000652:urine; D011518:Proto-Oncogene Proteins / Q000652:urine
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D015891:Cystatins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: acute kidney injury; biomarkers; cardiac surgery; children; cost effectiveness analysis