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Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis
BACKGROUND: Among people with chronic kidney disease (CKD) on dialysis, sub-optimal fluid management has been linked with hospitalisation, cardiovascular complications and death. This study assessed the cost-effectiveness using multiple-frequency bioimpedance guided fluid management versus standard...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077940/ https://www.ncbi.nlm.nih.gov/pubmed/33902602 http://dx.doi.org/10.1186/s12962-021-00276-6 |
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author | Jacobsen, Elisabet Cruickshank, Moira Cooper, David Marks, Angharad Brazzelli, Miriam Scotland, Graham |
author_facet | Jacobsen, Elisabet Cruickshank, Moira Cooper, David Marks, Angharad Brazzelli, Miriam Scotland, Graham |
author_sort | Jacobsen, Elisabet |
collection | PubMed |
description | BACKGROUND: Among people with chronic kidney disease (CKD) on dialysis, sub-optimal fluid management has been linked with hospitalisation, cardiovascular complications and death. This study assessed the cost-effectiveness using multiple-frequency bioimpedance guided fluid management versus standard fluid management based on clinical judgment. METHODS: A Markov model was developed to compare expected costs, outcomes and quality adjusted life years of the alternative management strategies. The relative effectiveness of the bioimpedance guided approach was informed by a systematic review of clinical trials, and focussed reviews were conducted to identify baseline event rates, costs and health state utility values for application in the model. The model was analysed probabilistically and a value of information (VOI) analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base. RESULTS: For the base-case analysis, the incremental cost-effectiveness ratio (ICER) for bioimpedance guided fluid management versus standard management was £16,536 per QALY gained. There was a 59% chance of the ICER being below £20,000 per QALY. Form the VOI analysis, the theoretical upper bound on the value of further research was £53 million. The value of further research was highest for parameters relating to the relative effectiveness of bioimpedance guided management on final health outcomes. CONCLUSIONS: Multiple frequency bioimpedance testing may offer a cost-effective approach to improve fluid management in patients with CKD on dialysis, but further research would be of value to reduce the current uncertainties. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12962-021-00276-6. |
format | Online Article Text |
id | pubmed-8077940 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-80779402021-04-29 Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis Jacobsen, Elisabet Cruickshank, Moira Cooper, David Marks, Angharad Brazzelli, Miriam Scotland, Graham Cost Eff Resour Alloc Research BACKGROUND: Among people with chronic kidney disease (CKD) on dialysis, sub-optimal fluid management has been linked with hospitalisation, cardiovascular complications and death. This study assessed the cost-effectiveness using multiple-frequency bioimpedance guided fluid management versus standard fluid management based on clinical judgment. METHODS: A Markov model was developed to compare expected costs, outcomes and quality adjusted life years of the alternative management strategies. The relative effectiveness of the bioimpedance guided approach was informed by a systematic review of clinical trials, and focussed reviews were conducted to identify baseline event rates, costs and health state utility values for application in the model. The model was analysed probabilistically and a value of information (VOI) analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base. RESULTS: For the base-case analysis, the incremental cost-effectiveness ratio (ICER) for bioimpedance guided fluid management versus standard management was £16,536 per QALY gained. There was a 59% chance of the ICER being below £20,000 per QALY. Form the VOI analysis, the theoretical upper bound on the value of further research was £53 million. The value of further research was highest for parameters relating to the relative effectiveness of bioimpedance guided management on final health outcomes. CONCLUSIONS: Multiple frequency bioimpedance testing may offer a cost-effective approach to improve fluid management in patients with CKD on dialysis, but further research would be of value to reduce the current uncertainties. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12962-021-00276-6. BioMed Central 2021-04-26 /pmc/articles/PMC8077940/ /pubmed/33902602 http://dx.doi.org/10.1186/s12962-021-00276-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Jacobsen, Elisabet Cruickshank, Moira Cooper, David Marks, Angharad Brazzelli, Miriam Scotland, Graham Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis |
title | Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis |
title_full | Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis |
title_fullStr | Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis |
title_full_unstemmed | Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis |
title_short | Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis |
title_sort | cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077940/ https://www.ncbi.nlm.nih.gov/pubmed/33902602 http://dx.doi.org/10.1186/s12962-021-00276-6 |
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