Abstract
Purpose
Many intensive care units (ICUs) have transitioned from systemic heparin anticoagulation (SHA) to regional citrate anticoagulation (RCA) for continuous kidney replacement therapy (CKRT). We evaluated the clinical and health economic impacts of ICU transition to RCA.
Materials and methods
We surveyed all adult general ICUs in England and Wales to identify transition dates and conducted a microcosting study in eight ICUs. We then conducted an interrupted time-series analysis of linked, routinely collected health records.
Results
In 69,001 patients who received CKRT (8585 RCA, 60,416 SHA) in 181 ICUs between 2009 and 2017, transition to RCA was not associated with a change in 90-day mortality (adjusted odds ratio 0.98, 95% CI 0.89– 1.08) but was associated with step-increases in duration of kidney support (0.53 days, 95% CI 0.28–0.79), advanced cardiovascular support (0.23 days, 95% CI 0.09–0.38) and ICU length of stay (0.86 days, 95% CI 0.24–1.49). The estimated one-year incremental net monetary benefit per patient was £−2376 (95% CI £−3841– £−911), with an estimated likelihood of cost-effectiveness of cost-effectiveness of
Conclusions
Transition to RCA was associated with significant increases in healthcare resource use, without corresponding clinical benefit, and is highly unlikely to be cost-effective over a one-year time horizon.
Many intensive care units (ICUs) have transitioned from systemic heparin anticoagulation (SHA) to regional citrate anticoagulation (RCA) for continuous kidney replacement therapy (CKRT). We evaluated the clinical and health economic impacts of ICU transition to RCA.
Materials and methods
We surveyed all adult general ICUs in England and Wales to identify transition dates and conducted a microcosting study in eight ICUs. We then conducted an interrupted time-series analysis of linked, routinely collected health records.
Results
In 69,001 patients who received CKRT (8585 RCA, 60,416 SHA) in 181 ICUs between 2009 and 2017, transition to RCA was not associated with a change in 90-day mortality (adjusted odds ratio 0.98, 95% CI 0.89– 1.08) but was associated with step-increases in duration of kidney support (0.53 days, 95% CI 0.28–0.79), advanced cardiovascular support (0.23 days, 95% CI 0.09–0.38) and ICU length of stay (0.86 days, 95% CI 0.24–1.49). The estimated one-year incremental net monetary benefit per patient was £−2376 (95% CI £−3841– £−911), with an estimated likelihood of cost-effectiveness of cost-effectiveness of
Conclusions
Transition to RCA was associated with significant increases in healthcare resource use, without corresponding clinical benefit, and is highly unlikely to be cost-effective over a one-year time horizon.
| Original language | English |
|---|---|
| Article number | 154218 |
| Number of pages | 31 |
| Journal | Journal of Critical Care |
| Volume | 74 |
| Early online date | 15 Feb 2023 |
| DOIs | |
| Publication status | Published - 1 Apr 2023 |
Bibliographical note
Funding Information:This work was supported by the UK National Institute for Health and Care Research (grant number 16/111/136 ).
Funding Information:
This work was supported by the UK National Institute for Health and Care Research (grant number 16/111/136).MO has received speaker honoraria and research funding from Fresenius Medical, speaker honoraria and research funding from Baxter, and is a member of an advisory board of Fresenius – NxStage. LF has received research funding from Baxter and lecture fees from Baxter and Fresenius. PW was Chief Medical Officer for Sensyne health and holds shares in the company. He declares grants from Wellcome, the National Institute for Health and Care Research, and Sensyne Health during the study period.
Publisher Copyright:
© 2022 The Authors