title: Economic impact of contrast-induced acute kidney injury associated with invasive cardiology: role of iso-osmolar contrast media in Germany, Italy, Poland, and Spain.
abstract: OBJECTIVE
  Iso-osmolar Iodixanol is associated with a lower rate of contrast-induced acute kidney injury (CI-AKI) in patients at increased risk compared to low-osmolar contrast media (LOCM). The aim of this study was to assess the financial consequences of CI-AKI risk reduction in patients undergoing coronary angiography (CA) with or without percutaneous coronary intervention (PCI) in German, Italian, Polish and Spanish hospitals.
  
  
  METHODS
  This budget impact analysis (BIA) compared a scenario with iodixanol to a scenario without, where only LOCM were used, in patients at increased risk of CI-AKI over a 3-year horizon. A meta-analysis based on a systematic review observed a lower rate of CI-AKI with iodixanol compared to LOCM (Risk Reduction = 0.46) in patients with underlying impaired renal function (serum creatinine ≥1.6 mg/dl and estimated glomerular filtration rate ≤50 ml/min/1.73 m(2)). Contrast media and CI-AKI hospitalization costs were included in the analysis and unit costs were obtained from published literature, official sources or, when available, from hospital data. In the absence of country-specific data, resource utilization for a CI-AKI hospitalization was obtained by interviews with local clinicians in each country. The percentage of patients who received iodixanol was assumed to increase over time.
  
  
  RESULTS
  Based on a percentage of patients at increased risk of CI-AKI equal to 20% in Germany, 24% in Italy, 23% in Poland and 10% in Spain, results showed that the introduction of iodixanol would bring a 3-years cumulative net percentage saving on the total hospital budget of 29%, 34%, 25%, and 33% in the four countries respectively.
  
  
  CONCLUSIONS
  The results of the analysis for the four countries showed that iodixanol use in patients at increased risk of CI-AKI undergoing CA with or without PCI may bring considerable savings on the hospital's budget, due to the associated reduction in CI-AKI incidence.
authors.affiliation: a a IMS Health , Vilvoorde , Belgium.
authors.forename: Maria
authors.initials: M
authors.lastname: De Francesco
authors.affiliation: b b San Bortolo Hospital , Vicenza , Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.affiliation: c c Medical University of Lublin , Lublin , Poland.
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Wacinski
authors.affiliation: d d Zentrum für Herz- Gefäss- und Lungenmedizin , Köln , Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Wessely
authors.affiliation: e e Hospital Universitario Doce de Octubre , Madrid , Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Hernández
authors.affiliation: a a IMS Health , Vilvoorde , Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: Lamotte
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D017023:Coronary Angiography; D005060:Europe; D006801:Humans; D061214:Patient Safety / Q000191:economics*; D062645:Percutaneous Coronary Intervention; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
chemical_list: D014283:Triiodobenzoic Acids; C044834:iodixanol
keywords: Acute kidney injury; Budget impact; Contrast media; Iodixanol