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ECONOMIC EVALUATION OF INTRAVENOUS IODINATED CONTRAST MEDIA IN ITALY

Published online by Cambridge University Press:  31 January 2014

Sergio Iannazzo ,
Stijn Vandekerckhove ,
Maria De Francesco ,
Akash Nayak ,
Claudio Ronco ,
Giovanni Morana  and
Massimo Valentino
Sergio Iannazzo
Affiliation:
SIHS Health Economics Consulting
Stijn Vandekerckhove
Affiliation:
IMS Health
Maria De Francesco
Affiliation:
IMS Health
Akash Nayak
Affiliation:
San Bortolo Hospital
Claudio Ronco
Affiliation:
San Bortolo Hospital
Giovanni Morana
Affiliation:
Ca'Foncello Hospital
Massimo Valentino
Affiliation:
S. Antonio Abate Hospital
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Abstract

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.

Conclusion: 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.

Keywords

Contrast-induced acute kidney injury (CI-AKI)cost-effectiveness analysisiodixanolItalyhealth economic model
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 1 , January 2014 , pp. 69 - 77
Copyright
Copyright © Cambridge University Press 2014 

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