Journal of medical economics · 2025
Projected hospitalization cost impact of the selective cytopheretic device in pediatric acute kidney injury.
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Humes H David, Kleinman Nathan, Kammerer Jennifer, Iyer Sai Prasad N, Goldstein Stuart L, Kleinman Alec, Chung Kevin K, Thakar Charuhas V
Аннотация
AIMS: The Selective Cytopheretic Device for Pediatrics (SCD-PED) is a cell-directed extracorporeal therapy approved by the Food and Drug Administration through the humanitarian device exemption pathway for patients≥10kg, age≤22 years with acute kidney injury due to sepsis or a septic condition requiring antibiotics and on continuous renal replacement therapy (CRRT). We leveraged the Kids' Inpatient Database (KID) and SCD-PED study data to estimate hospitalization costs with and without SCD-PED therapy.
MATERIALS AND METHODS: A cost regression model was built from KID hospitalizations (2019) that included patients aged 1-20 years with AKI receiving CRRT, total parenteral nutrition, KID mortality risk=4, KID severity=4, and hospital length of stay (LOS) ≤60 days. Data assessed as cost predictors included patient age, sex, vasopressor use, mechanical ventilation, sepsis, theoretical SCD-PED cost/number used, LOS, and death at hospital discharge. Differences in mean costs between a matched control cohort from the Prospective Pediatric CRRT registry (ppCRRT) and the SCD-PED study cohort were estimated from the model using SCD-PED study mortality rates and LOS reported in the SCD-PED studies.
RESULTS: Modeled hospitalization costs were $457,092 in KID cohort (N = 106), reflecting comparable heterogeneity and complexity. Modeled hospitalization costs were $389,451 in ppCRRT (N = 210). Median hospital LOS was lower in the SCD-PED group (N = 22): 28 days vs. 31 days in the control group, which despite the lower mortality rate, resulted in a lower estimated cost of $320,304, reflecting an estimated savings of $69,146 per hospitalization.
LIMITATIONS: The model in the current study compares patients using SCD-PED to an external control cohort with similar characteristics, because controls were not examined in the original clinical studies. This study is not intended to be predictive of costs in other patient types or larger populations. Additional study is needed.
CONCLUSIONS: The SCD-PED is likely cost-beneficial in critically ill children with AKI requiring CRRT, including those with sepsis.
MATERIALS AND METHODS: A cost regression model was built from KID hospitalizations (2019) that included patients aged 1-20 years with AKI receiving CRRT, total parenteral nutrition, KID mortality risk=4, KID severity=4, and hospital length of stay (LOS) ≤60 days. Data assessed as cost predictors included patient age, sex, vasopressor use, mechanical ventilation, sepsis, theoretical SCD-PED cost/number used, LOS, and death at hospital discharge. Differences in mean costs between a matched control cohort from the Prospective Pediatric CRRT registry (ppCRRT) and the SCD-PED study cohort were estimated from the model using SCD-PED study mortality rates and LOS reported in the SCD-PED studies.
RESULTS: Modeled hospitalization costs were $457,092 in KID cohort (N = 106), reflecting comparable heterogeneity and complexity. Modeled hospitalization costs were $389,451 in ppCRRT (N = 210). Median hospital LOS was lower in the SCD-PED group (N = 22): 28 days vs. 31 days in the control group, which despite the lower mortality rate, resulted in a lower estimated cost of $320,304, reflecting an estimated savings of $69,146 per hospitalization.
LIMITATIONS: The model in the current study compares patients using SCD-PED to an external control cohort with similar characteristics, because controls were not examined in the original clinical studies. This study is not intended to be predictive of costs in other patient types or larger populations. Additional study is needed.
CONCLUSIONS: The SCD-PED is likely cost-beneficial in critically ill children with AKI requiring CRRT, including those with sepsis.