Postoperative Cost-effectiveness of Prophylactic Amino Acid Therapy for Renal Protection: A Modeled Economic Evaluation.

OBJECTIVE

To assess the cost-effectiveness of intravenous amino acids (AA) versus placebo in decreasing cardiac surgery-associated acute kidney injury (AKI) among adult patients after cardiac surgery.

DESIGN

Data on resource use and outcomes were obtained from relevant studies reported in a recent meta-analysis. Cost-effectiveness analyses were conducted using a decision tree model to quantify the incremental costs and health outcomes of AA versus placebo.

SETTING

Cost-effectiveness analyses were conducted separately for Australia, the United States, China, Italy, and the United Kingdom using local unit costs.

PARTICIPANTS

Adult patients after cardiac surgery.

INTERVENTIONS: Intravenous AA versus placebo.

MEASUREMENTS AND MAIN

RESULTS

The cost-effectiveness analyses expressed outcomes in terms of cost per instance of AKI averted with an in-hospital time horizon and from a healthcare payer perspective. The expected total healthcare cost after surgery in patients treated with AA ranged from $1,871 in China to $37,692 in the United States versus $2,055 in China to $40,213 in the United States for the placebo group, with a per patient cost saving ranging from $184 (95% confidence interval [CI], -$331 to -$32) in China to $2,521 (95% CI, -$3,770 to -$1,260) in the United States. AA also resulted in a 5.2% (95% CI, 5.1%-5.3%) absolute risk reduction in AKI. AA was dominant (cost-saving and cost-effective) across all jurisdictions.

CONCLUSIONS

Compared with placebo, AA infusion decreases the occurrence of AKI and is cost-saving. Perioperative AA therapy is a rational approach to patient care that simultaneously protects renal function and decreases healthcare costs.