OBJECTIVES: Persistent severe AKI (PS-AKI), defined as stage 3 AKI lasting ≥3 days or with death in ≤3 days, or stage 2-3 AKI with dialysis in ≤3 days, occurs in 25% of hospitalized stage 2-3 AKI patients, resulting in poor clinical outcomes and high costs. This analysis aimed to assess the cost-utility of CCL14 to identify PS-AKI, compared to standard of care (SOC) alone, in hospitalized stage 2-3 AKI patients in Spain and the UK.

METHODS: A decision tree was populated with CCL14 diagnostic operating characteristics to estimate the probability of PS-AKI and 90-day clinical outcomes. A Markov model with 90-day cycles simulated consequences over a lifetime horizon. Costs and quality-adjusted life years (QALYs) were estimated for index admission, 30-day readmission, intensive care requirement, dialysis dependence, and death. In the absence of local data, a large retrospective cohort of US hospitals informed the impact of PS-AKI on clinical outcomes. A literature review returned suitable costs and utilities, which were combined using the national healthcare service perspective from each country. Effects and costs of an intervention reducing PS-AKI incidence, and testing costs were varied in two- and tree-way sensitivity analyses. Parameters uncertainty was explored in a probabilistic sensitivity analysis. Model results were synthesized as incremental cost-effectiveness ratios. Costs and outcomes were discounted at 3% and 3.5% in the Spanish and UK models, respectively.

RESULTS: By preventing PS-AKI in as few as 10% of true positive cases, a CCL14-informed clinical practice resulted in QALYs gain in both countries. CCL14 was associated with lower costs (dominating) and a high probability of being cost-effective at the €30,000/QALY and £20,000/QALY thresholds. The results were robust to extensive sensitivity analyses.

CONCLUSIONS: By identifying individuals at high risk of PS-AKI, CCL14 is likely to be cost-effective to guide hospital clinical practice in Spain and the UK.