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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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References

REFERENCES

1. ACR Committee on Drugs and Contrast Media. ACR manual on contrast media, version 7. 2010. American College of Radiology. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/ABCD%20Approach%20for%20Patient%20Evaluation%20and%20Treatment.pdf. (Accessed July 2012).Google Scholar
2. Kellum, JA, Bellomo, R, Ronco, C. Kidney attack. JAMA. 2012;307:2265–2266.CrossRefGoogle ScholarPubMed
3. Haase, M, Kellum, JA, Ronco, C. Subclinical AKI-an emerging syndrome with important consequences. Nat Rev Nephrol. 2012;8:735–739.CrossRefGoogle ScholarPubMed
4. Wang, HE, Muntner, P, Chertow, GM, Warnock, DG. Acute kidney injury and mortality in hospitalized patients. Am J Nephrol. 2012;35:349–355.CrossRefGoogle ScholarPubMed
5. Chertow, GM, Burdick, E, Honour, M, et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365–3370.CrossRefGoogle ScholarPubMed
6. Ricci, Z, Cruz, DN, Ronco, C. Classification and staging of acute kidney injury: Beyond the RIFLE and AKIN criteria. Nat Rev Nephrol. 2011;7:201–208.CrossRefGoogle ScholarPubMed
7. Canadian Association of Radiologists. Guidelines for the prevention of contrast induced nephropathy. Owen RJ, Hiremath S, Myers A, Fraser-Hill M, Barrett B. Approved: June 17, 2011. www.car.ca. (Accessed July 2012).Google Scholar
8. Aspelin, P, Aubry, P, Fransson, SG, Strasser, R, Willenbrock, R, Berg, KJ. Nephrotoxicity in high-risk patients study of iso-osmolar and low-osmolar non-ionic contrast media study investigators. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348:491–499.CrossRefGoogle Scholar
9. McCullough, PA, Brown, JR. Effects of intra-arterial and intravenous iso-osmolar contrast medium (iodixanol) on the risk of contrast-induced acute kidney injury: A meta-analysis. Cardiorenal Med. 2011;1:220–234.CrossRefGoogle ScholarPubMed
10. Davidson, C, Stacul, F, McCullough, PA, et al. CIN Consensus Working Panel. Contrast medium use. Am J Cardiol. 2006;98:42K–58K.CrossRefGoogle ScholarPubMed
11. Aspelin, P, Aubry, P, Fransson, SG, et al. Cost-effectiveness of iodixanol in patients at high risk of contrast-induced nephropathy. Am Heart J. 2005;149:298–303.CrossRefGoogle ScholarPubMed
12. Colombo, GL, Lundkvist, J, Caruggi, M, Serra, G, Vinci, M. Cost analysis in patients at high risk o f contrast induced nephropathy: Italian results of the NEPHRIC study. Pharmacoeconomics. 2005;7:145–154.Google Scholar
13. Lencioni, R, Fattori, R, Morana, G, Stacul, F. Contrast-induced nephropathy in patients undergoing computed tomography (CONNECT) - a clinical problem in daily practice? A multicenter observational study. Acta Radiol. 2010;51:741–750.CrossRefGoogle Scholar
14. Nguyen, SA, Suranyi, P, Ravenel, JG, et al. Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous contrast-enhanced CT: Effect on kidney function. Radiology. 2008;248:97–105.CrossRefGoogle ScholarPubMed
15. Mehran, R, Aymong, ED, Nikolsky, E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention. J Am Coll Cardiol. 2004;44:1393–1399.Google ScholarPubMed
16. Framingham Heart Study. Coronary heart disease 10-year risk. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–1847. http://www.framinghamheartstudy.org/risk/coronary.html (Accessed July 2012).CrossRefGoogle Scholar
17. Rihal, CS, Textor, SC, Grill, DE, et al. 2002. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105:2259–2264.CrossRefGoogle ScholarPubMed
18. ISTAT – National Institute of Statistics. Tables of mortality of the general population by age and sex. Data 2009. http://www.demo.istat.it/index_e.htm (Accessed July 2012).Google Scholar
19. Italian Drug Formulary. ReFI – Prontuario Farmaceutico Italiano. 2012. http://www.prontuariofarmaceutico.it/ (Accessed May 2012).Google Scholar
20. Report Multiclient ECMIG 2011 per le Aziende farmaceutiche di settore. GE Healthcare, data on file.Google Scholar
21. Region Lombardy. Dati relativi alla aggiudicazione della gara regionale per farmaci di contrasto – Lombardia Informatica e Assessorato regionale alla sanità regione Lombardia, 2011.Google Scholar
22. Ministry of Health. DRG, 2006. DECRETO 12 Settembre 2006 Ricognizione e primo aggiornamento delle tariffe massime per la remunerazione delle prestazioni sanitarie. GU n. 289 del 13-12-2006- Suppl. Ordinario n.234. Roma: Ministero della Salute.Google Scholar
23. SDO. Italian hospital discharge database. 2010. http://www.salute.gov.it/ricoveriOspedalieri/paginaInternaRicoveriOspedalieri.jsp?menu=banca&id=1236&lingua=italiano (Accessed July 2012).Google Scholar
24. Messori, A, Santarlasci, B, Trippoli, S, Vaiani, M. Controvalore economico del farmaco e beneficio clinico: Stato dell'arte della metodologia e applicazione di un algoritmo farmacoeconomico. Pharmacoeconomics. 2003;5:53–56.Google Scholar
25. Briggs, A. Handling uncertainty in economic evaluations and presenting the results. In: Drummond, M, McGuire, A, eds. Economic evaluation in health care. New York: Oxford University Press; 2001:172–214.CrossRefGoogle Scholar
26. Arana, E, Catalá-López, F. Cost-effectiveness of iodinated contrast media for CT scanning in Spain: A decision-based analysis. Imaging Med. 2012;4:193–199.CrossRefGoogle Scholar
27. Heinrich, MC, Häberle, L, Müller, V, Bautz, W, Uder, M. Nephrotoxicity of iso-osmolar iodixanol compared with non-ionic low-osmolar contrast media: Meta-analysis of randomized controlled trials. Radiology. 2009;250:68–86.CrossRefGoogle Scholar
28. From, AM, Al Badarin, FJ, McDonald, FS, et al. Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy: Meta-analysis of randomized, controlled trials. Circ Cardiovasc Interv. 2010;3:351–358.CrossRefGoogle ScholarPubMed
29. Lapi, F, Cecchi, E, Pedone, C. et al. Safety aspects of iodinated contrast media related to their physicochemical properties: A pharmacoepidemiology study in two Tuscany hospitals. Eur J Clin Pharmacol. 2008;64:723–737.CrossRefGoogle Scholar
30. De Marco, R, Locatelli, F, Zoppini, G, et al. Cause – Specific mortality in type 2 diabetes. Diabetes Care. 1999;22:756–761.CrossRefGoogle ScholarPubMed
31. Raymond, N, Zehnder, D, Smith, S, et al. Elevated relative mortality risk with mild-to-moderate chronic kidney disease decreases with age. Nephrology Dialysis Transplantation. 2007;22:3214–3220.Google Scholar
32. Framingham Heart Study. Recurring Coronary Heart Disease 2-year risk. 2000. Primary and subsequent coronary risk appraisal: New results from the Framingham Study. Am Heart J. http://www.framinghamheartstudy.org/risk/recurr.html (Accessed July 1, 2012).Google Scholar
33. IN-CH. Il database dell'Italian Network on Congestive Heart Failure (IN-CHF): risultati e prospettive. Atti del Convegno. Naples, Italy; 1999.Google Scholar
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