Table 2.
Main inputs used in the model
| Parameters | Mean | Distribution | Lower limit | Upper limit | Sources |
|---|---|---|---|---|---|
| Population size | |||||
| % of patients undergoing DAG and/or PCI with CKD stage 3–4 | 27% | Fixed | NA | NA | Dangas et al. [3] |
| Number of patients undergoing DAG only | 145,046 | Fixed | NA | NA | NHS reference cost [22] |
| Number of patients undergoing PCI only | 20,843 | Fixed | NA | NA | |
| Number of patients undergoing DAG and PCI | 58,286 | Fixed | NA | NA | |
| % of extended hospital admissions compared to new admissions | 50% | Fixed | NA | NA | Assumption |
| Transition probabilities | |||||
| Decision tree (3 month) probabilities | |||||
| CKD 3–4 to CI-AKI | 0.30 | Beta | 0.26 | 0.352 | Dangas et al. [3] |
| RR reduction of CI-AKI due to DyeVert™ | 0.21 | Log normal | 0.16 | 0.268 | Gurm et al. [23] |
| HR of CI-AKI to death | 2.13 | Log normal | 2.01 | 2.260 | Valle et al. [12] |
| Markov model (long term) | |||||
| CI-AKI to CKD 5 | 3.28% | Beta | 3.10% | 3.46% | James et al. [21] |
| CKD 3–4 to CKD 5 | |||||
| < 69 years | 0.02% | Beta | Alpha 5.50 | Beta 3043.00 | Eriksen et al. [20] and CG169 [24] |
| 70–79 years | 0.10% | Beta |
Alpha 3.1 |
Beta 3045.0 | |
| > 79 years | 0.08% | Beta |
Alpha 2.3 |
Beta 3046.0 | |
| Risk of recurrent AKI, first 3 months (without previous CI-AKI) | 1.78% | Beta | 1.74% | 1.82% | Valle et al. [12] |
| Risk of recurrent AKI, subsequent (without previous CI-AKI) | 0.91% | Beta | 0.49% | 0.50% | |
| Risk of recurrent AKI, first 3 months (with previous CI-AKI) | 6.61% | Beta | 6.24% | 6.96% | |
| Risk of recurrent AKI, subsequent (with previous CI-AKI) | 2.26% | Beta | 2.20% | 2.32% | |
| Risk of MI, acute phase (with previous CI-AKI) | 2.58% | Beta | 2.35% | 2.82% | |
| Risk of MI, subsequent (with previous CI-AKI) | 1.23% | Beta | 1.18% | 1.28% | |
| Risk of MI, acute phase (without previous CI-AKI) | 1.42% | Beta | 1.36% | 2.35% | |
| Risk of MI, subsequent (without previous CI-AKI) | 0.67% | Beta | 0.64% | 1.11% | |
| Risk of AKI requiring dialysis, acute phase (with previous CI-AKI) | 0.79% | Beta | 0.65% | 0.93% | |
| Risk of AKI requiring dialysis, subsequent (with previous CI-AKI) | 0.16% | Beta | 0.15% | 0.18% | |
| Risk of AKI requiring dialysis, acute phase (without previous CI-AKI) | 0.11% | Beta | 0.11% | 0.12% | |
| Risk of AKI requiring dialysis, subsequent (without previous CI-AKI) | 0.04% | Beta | 0.04% | 0.04% | |
| Mortality | |||||
| CKD 3–4 to death RR (conditional on age and gender) | |||||
| Male < 69 years | 3.60 | Log normal | 2.60 | 5.000 | Eriksen et al. [20] |
| Female < 69 years | 2.70 | Log normal | 2.00 | 3.700 | |
| Male 70–79 years | 2.40 | Log normal | 2.00 | 2.900 | |
| Female 70–79 years | 1.80 | Log normal | 1.50 | 2.100 | |
| Male > 79 | 2.30 | Log normal | 2.00 | 2.600 | |
| Female > 79 | 2.10 | Log normal | 1.90 | 2.300 | |
| CKD 5 to death RR (conditional on age and gender) | |||||
| Male 18–64 years | 10.00 | Log normal | 7.10 | 13.700 | Villar et al. [25] |
| Female 18–64 years | 16.40 | Log normal | 9.60 | 26.300 | |
| Male > 64 years | 4.80 | Log normal | 3.90 | 5.800 | |
| Female > 64 years | 7.10 | Log normal | 5.40 | 9.200 | |
| Relative risk of stage 5 CKD after CI-AKI | 4.81 | Log normal | 3.04 | 7.62 | See et al. [5] |
| MI (acute) to death SMR | 5.84 | Log normal | 4.38 | 7.300 | TA236 [26] |
| MI (subsequent) to death SMR | 2.21 | Log normal | 1.66 | 2.763 | |
| Costs | |||||
| Health-state costs/cycle | |||||
| CKD stage 3–4/cycle | £279.78 | Gamma | £209.83 | £349.72 | NHS reference cost [22] |
| CKD stage 5 in first cycle/cycle | £7006.45 | Gamma | £5254.84 | £8758.06 | |
| CKD stage 5 in subsequent cycles/cycle | £6048.95 | Gamma | £4536.71 | £7561.19 | |
| Cost of MI (initial)/cycle | £6249.79 | Gamma | £6109.65 | £6389.92 | Walker et al. [27] |
| Cost of MI (subsequent)/cycle | £502.56 | Gamma | £447.99 | £557.12 | |
| Event costs and other | |||||
| CI-AKI cost of index admission | £2673.79 | Gamma | £2005.35 | £3342.24 | NHS digital 2017–2018 NHS reference cost [22] |
| CI-AKI cost of extended hospital admission | £1726.34 | Gamma | £1294.75 | £2157.92 | NHS digital 2017–2018 NHS reference cost [22] |
| DyeVert™ cost | £350.00 | Gamma | Osprey Medical Corporation [28] | ||
| Cost of DAG | £1766.21 | Gamma | £1324.66 | £2207.77 | NHS digital 2017–2018 NHS reference cost [22] |
| Cost of PCI | £2937.22 | Gamma | £2202.91 | £3671.52 | NHS digital 2017–2018 NHS reference cost [22] |
| Health utilities | |||||
| CKD stage 3–4/cycle | 0.17 | Beta | 0.12 | 0.22 | Tajima et al. [29] and Kind et al. [30] |
| CKD stage 5/cycle | 0.16 | Beta | 0.11 | 0.20 | |
| CI-AKI/cycle | 0.13 | Beta | 0.07 | 0.20 | Sullivan et al. [31] |
| Post myocardial infarction/cycle | 0.17 | Beta | 0.12 | 0.22 | Assumption |
AKI acute kidney injury, DAG diagnostic coronary angiography, CI-AKI contrast-induced acute kidney injury, CKD chronic kidney disease, MI myocardial infarction, PCI percutaneous coronary intervention, RR relative risk