Randomized Controlled Trial Evidence of Cost-Effectiveness of a Multifaceted AKI Intervention Approach

Introduction: Acute kidney injury (AKI) is associated with increased health care utilization and higher costs. The Tackling AKI study was a multicenter, pragmatic, stepped-wedge cluster randomized trial that demonstrated a reduced hospital length of stay after implementation of a multifaceted AKI intervention (e-alerts, care bundle, and an education program). We tested whether this would result in cost savings. Methods: A decision-analytic tree model from the payer perspective (National Health Service in the United Kingdom) was generated on which cost-effectiveness analyses were performed using a probabilistic sensitivity analysis, accounting only for direct medical costs. Clinical data from the Tackling AKI study were used as inputs and economic and utility data derived from relevant published literature. Results: A total of 24,059 AKI episodes occurred during the study period, and in 18,887 admissions the patient was discharged alive. When all AKI stages were considered together, the cost per AKI admission was 5065 pound in the control arm and 4333 pound in the intervention arm, representing an incremental cost saving of 732 pound per admission with the intervention. Similar results were obtained when AKI stages were included as separate variables. Costs per quality-adjusted life year were 61,194 pound in the control group and 51,161 pound in the intervention group. At a willingness to pay threshold of 20,000 pound per quality-adjusted life year, the probability of the intervention being cost-effective compared with standard care was 90%. Conclusion: An organizational level approach to improve standards of AKI care reduces the cost of hospital admissions and is cost effective within the National Health Service in the United Kingdom.