PMID- 34339953
OWN - NLM
STAT- MEDLINE
DCOM- 20210825
LR  - 20220531
IS  - 1872-7727 (Electronic)
IS  - 0720-048X (Linking)
VI  - 142
DP  - 2021 Sep
TI  - Cost-effectiveness of point-of-care creatinine testing to assess kidney function 
      prior to contrast-enhanced computed tomography imaging.
PG  - 109872
LID - S0720-048X(21)00353-3 [pii]
LID - 10.1016/j.ejrad.2021.109872 [doi]
AB  - BACKGROUND: Patients undergoing contrast-enhanced computed tomography (CECT) 
      imaging in a non-emergency outpatient setting often lack a recent estimated 
      Glomerular Filtration Rate measurement. This may lead to inefficiencies in the 
      CECT pathway. The use of point-of-care (POC) creatinine tests to evaluate kidney 
      function in these patients may provide a safe and cost-effective alternative to 
      current practice, as these can provide results within the same CECT appointment. 
      METHODS: A decision tree model was developed to characterise the diagnostic 
      pathway and patient management (e.g., intravenous hydration) and link these to 
      adverse renal events associated with intravenous contrast media. Twelve 
      diagnostic strategies including three POC devices (i-STAT, ABL800 Flex and 
      StatSensor), risk factor screening and laboratory testing were compared with 
      current practice. The diagnostic accuracy of POC devices was derived from a 
      systematic review and meta-analysis; relevant literature sources and databases 
      informed other parameters. The cost-effective strategy from a health care 
      perspective was identified based on highest net health benefit (NHB) which were 
      expressed in quality-adjusted life years (QALYs) at  pound20,000/QALY. RESULTS: The 
      cost-effective strategy, with a NHB of 9.98 QALYs and a probability of being 
      cost-effective of 79.3%, was identified in our analysis to be a testing sequence 
      involving screening all individuals for risk factors, POC testing (with i-STAT) 
      on those screening positive, and performing a confirmatory laboratory test for 
      individuals with a positive POC result. The incremental NHB of this strategy 
      compared to current practice, confirmatory laboratory test, is 0.004 QALYs. 
      Results were generally robust to scenario analysis. CONCLUSIONS: A testing 
      sequence combining a risk factor questionnaire, POC test and confirmatory 
      laboratory testing appears to be cost-effective compared to current practice. The 
      cost-effectiveness of POC testing appears to be driven by reduced delays within 
      the CECT pathway. The contribution of intravenous contrast media to acute kidney 
      injury, and the benefits and harms of intravenous hydration remain uncertain.
CI  - Copyright (c) 2021 Elsevier B.V. All rights reserved.
FAU - Duarte, Ana
AU  - Duarte A
AD  - Centre for Health Economics, University of York, Heslington, UK. Electronic 
      address: ana.duarte@york.ac.co.uk.
FAU - Walker, Simon
AU  - Walker S
AD  - Centre for Health Economics, University of York, Heslington, UK.
FAU - Altunkaya, James
AU  - Altunkaya J
AD  - Nuffield Department of Population Health, University of Oxford, Oxford, UK.
FAU - Dias, Sofia
AU  - Dias S
AD  - Centre for Reviews and Dissemination, University of York, Heslington, UK.
FAU - Corbett, Mark
AU  - Corbett M
AD  - Centre for Reviews and Dissemination, University of York, Heslington, UK.
FAU - Llewellyn, Alexis
AU  - Llewellyn A
AD  - Centre for Reviews and Dissemination, University of York, Heslington, UK.
FAU - Harris, Martine A
AU  - Harris MA
AD  - Mid Yorkshire NHS Hospitals Trust, Wakefield, UK.
FAU - Palmer, Stephen
AU  - Palmer S
AD  - Centre for Health Economics, University of York, Heslington, UK.
FAU - Soares, Marta
AU  - Soares M
AD  - Centre for Health Economics, University of York, Heslington, UK.
LA  - eng
PT  - Journal Article
DEP - 20210727
PL  - Ireland
TA  - Eur J Radiol
JT  - European journal of radiology
JID - 8106411
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Cost-Benefit Analysis
MH  - Creatinine
MH  - Humans
MH  - Kidney
MH  - Meta-Analysis as Topic
MH  - *Point-of-Care Systems
MH  - Systematic Reviews as Topic
MH  - *Tomography, X-Ray Computed
OTO - NOTNLM
OT  - Computed tomography
OT  - Contrast media
OT  - Cost-effectiveness
OT  - Creatinine
OT  - Point-of-care
OT  - Post-contrast acute kidney injury
EDAT- 2021/08/03 06:00
MHDA- 2021/08/26 06:00
CRDT- 2021/08/02 20:19
PHST- 2021/05/06 00:00 [received]
PHST- 2021/07/14 00:00 [revised]
PHST- 2021/07/20 00:00 [accepted]
PHST- 2021/08/03 06:00 [pubmed]
PHST- 2021/08/26 06:00 [medline]
PHST- 2021/08/02 20:19 [entrez]
AID - S0720-048X(21)00353-3 [pii]
AID - 10.1016/j.ejrad.2021.109872 [doi]
PST - ppublish
SO  - Eur J Radiol. 2021 Sep;142:109872. doi: 10.1016/j.ejrad.2021.109872. Epub 2021 
      Jul 27.