Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis

Elisabet Jacobsen; Moira Cruickshank; David Cooper; Angharad Marks; Miriam Brazzelli; Graham Scotland

doi:10.1186/s12962-021-00276-6

Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis

Elisabet Jacobsen^* (Corresponding Author), Moira Cruickshank, David Cooper, Angharad Marks, Miriam Brazzelli, Graham Scotland

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

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Abstract

Abstract
Background
Among people with chronic kidney disease (CKD) on dialysis, sub-optimal fluid management has been linked with hospitalisation, cardiovascular complications and death. This study assessed the cost-effectiveness using multiple-frequency bioimpedance guided fluid management versus standard fluid management based on clinical judgment.

Methods
A Markov model was developed to compare expected costs, outcomes and quality adjusted life years of the alternative management strategies. The relative effectiveness of the bioimpedance guided approach was informed by a systematic review of clinical trials, and focussed reviews were conducted to identify baseline event rates, costs and health state utility values for application in the model. The model was analysed probabilistically and a value of information (VOI) analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base.

Results
For the base-case analysis, the incremental cost-effectiveness ratio (ICER) for bioimpedance guided fluid management versus standard management was £16,536 per QALY gained. There was a 59% chance of the ICER being below £20,000 per QALY. Form the VOI analysis, the theoretical upper bound on the value of further research was £53 million. The value of further research was highest for parameters relating to the relative effectiveness of bioimpedance guided management on final health outcomes.

Conclusions
Multiple frequency bioimpedance testing may offer a cost-effective approach to improve fluid management in patients with CKD on dialysis, but further research would be of value to reduce the current uncertainties.

Original language	English
Article number	24
Number of pages	10
Journal	Cost Effectiveness and Resource Allocation
Volume	19
Early online date	26 Apr 2021
DOIs	https://doi.org/10.1186/s12962-021-00276-6
Publication status	Published - 2021

Bibliographical note

Acknowledgements
The authors would like to thank the Thomas Walker and Rebecca Albrow (National Institute for Health and Care Excellence) for comments on earlier versions of the model. We also wish to thank the NICE expert committee members who provided information and data to support the development of the model: Dr Andrew Davenport (Royal Free Hospital, London), Dr Simon Roe (Nottingham University Hospitals NHS Trust), Dr Elizabeth Lindley (St James’s University Hospital), Dr Wesley Hayes (Great Ormond Street Hospital), Ms Joanne Prince (Central Manchester University Hospitals NHS Foundation Trust), Mr Nick McAleer (Royal Devon & Exeter NHS Foundation Trust), Dr Kay Tyerman (Leeds General Infirmary), Dr Graham Woodrow (St James’s University Hospital) and Mr Paul Taylor (lay specialist committee member).

Funding
This paper presents independent research funded by the National Institute for Health Research (NIHR), commissioned through the NICE Diagnostic Assessment Programme (Project no 15/17/07). The views expressed are those of the authors and not necessarily those of NICE, the NHS, the NIHR or the Department of Health. The Health Economics Research Unit and the Health Services Research Unit, University of Aberdeen, are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Keywords

Multiple frequency bioimpedance devices
BCM-Body Composition Monitor
Cost-effectiveness
Value of information analysis

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Cite this

Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis. / Jacobsen, Elisabet (Corresponding Author); Cruickshank, Moira ; Cooper, David et al.
In: Cost Effectiveness and Resource Allocation, Vol. 19, 24, 2021.

Research output: Contribution to journal › Article › peer-review

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title = "Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis",

abstract = "AbstractBackgroundAmong people with chronic kidney disease (CKD) on dialysis, sub-optimal fluid management has been linked with hospitalisation, cardiovascular complications and death. This study assessed the cost-effectiveness using multiple-frequency bioimpedance guided fluid management versus standard fluid management based on clinical judgment.MethodsA Markov model was developed to compare expected costs, outcomes and quality adjusted life years of the alternative management strategies. The relative effectiveness of the bioimpedance guided approach was informed by a systematic review of clinical trials, and focussed reviews were conducted to identify baseline event rates, costs and health state utility values for application in the model. The model was analysed probabilistically and a value of information (VOI) analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base.ResultsFor the base-case analysis, the incremental cost-effectiveness ratio (ICER) for bioimpedance guided fluid management versus standard management was £16,536 per QALY gained. There was a 59% chance of the ICER being below £20,000 per QALY. Form the VOI analysis, the theoretical upper bound on the value of further research was £53 million. The value of further research was highest for parameters relating to the relative effectiveness of bioimpedance guided management on final health outcomes.ConclusionsMultiple frequency bioimpedance testing may offer a cost-effective approach to improve fluid management in patients with CKD on dialysis, but further research would be of value to reduce the current uncertainties.",

keywords = "Multiple frequency bioimpedance devices, BCM-Body Composition Monitor, Cost-effectiveness, Value of information analysis",

author = "Elisabet Jacobsen and Moira Cruickshank and David Cooper and Angharad Marks and Miriam Brazzelli and Graham Scotland",

note = "Acknowledgements The authors would like to thank the Thomas Walker and Rebecca Albrow (National Institute for Health and Care Excellence) for comments on earlier versions of the model. We also wish to thank the NICE expert committee members who provided information and data to support the development of the model: Dr Andrew Davenport (Royal Free Hospital, London), Dr Simon Roe (Nottingham University Hospitals NHS Trust), Dr Elizabeth Lindley (St James{\textquoteright}s University Hospital), Dr Wesley Hayes (Great Ormond Street Hospital), Ms Joanne Prince (Central Manchester University Hospitals NHS Foundation Trust), Mr Nick McAleer (Royal Devon & Exeter NHS Foundation Trust), Dr Kay Tyerman (Leeds General Infirmary), Dr Graham Woodrow (St James{\textquoteright}s University Hospital) and Mr Paul Taylor (lay specialist committee member). Funding This paper presents independent research funded by the National Institute for Health Research (NIHR), commissioned through the NICE Diagnostic Assessment Programme (Project no 15/17/07). The views expressed are those of the authors and not necessarily those of NICE, the NHS, the NIHR or the Department of Health. The Health Economics Research Unit and the Health Services Research Unit, University of Aberdeen, are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.",

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volume = "19",

journal = "Cost Effectiveness and Resource Allocation",

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AU - Jacobsen, Elisabet

AU - Cruickshank, Moira

AU - Cooper, David

AU - Marks, Angharad

AU - Brazzelli, Miriam

AU - Scotland, Graham

N1 - Acknowledgements The authors would like to thank the Thomas Walker and Rebecca Albrow (National Institute for Health and Care Excellence) for comments on earlier versions of the model. We also wish to thank the NICE expert committee members who provided information and data to support the development of the model: Dr Andrew Davenport (Royal Free Hospital, London), Dr Simon Roe (Nottingham University Hospitals NHS Trust), Dr Elizabeth Lindley (St James’s University Hospital), Dr Wesley Hayes (Great Ormond Street Hospital), Ms Joanne Prince (Central Manchester University Hospitals NHS Foundation Trust), Mr Nick McAleer (Royal Devon & Exeter NHS Foundation Trust), Dr Kay Tyerman (Leeds General Infirmary), Dr Graham Woodrow (St James’s University Hospital) and Mr Paul Taylor (lay specialist committee member). Funding This paper presents independent research funded by the National Institute for Health Research (NIHR), commissioned through the NICE Diagnostic Assessment Programme (Project no 15/17/07). The views expressed are those of the authors and not necessarily those of NICE, the NHS, the NIHR or the Department of Health. The Health Economics Research Unit and the Health Services Research Unit, University of Aberdeen, are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

PY - 2021

Y1 - 2021

N2 - AbstractBackgroundAmong people with chronic kidney disease (CKD) on dialysis, sub-optimal fluid management has been linked with hospitalisation, cardiovascular complications and death. This study assessed the cost-effectiveness using multiple-frequency bioimpedance guided fluid management versus standard fluid management based on clinical judgment.MethodsA Markov model was developed to compare expected costs, outcomes and quality adjusted life years of the alternative management strategies. The relative effectiveness of the bioimpedance guided approach was informed by a systematic review of clinical trials, and focussed reviews were conducted to identify baseline event rates, costs and health state utility values for application in the model. The model was analysed probabilistically and a value of information (VOI) analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base.ResultsFor the base-case analysis, the incremental cost-effectiveness ratio (ICER) for bioimpedance guided fluid management versus standard management was £16,536 per QALY gained. There was a 59% chance of the ICER being below £20,000 per QALY. Form the VOI analysis, the theoretical upper bound on the value of further research was £53 million. The value of further research was highest for parameters relating to the relative effectiveness of bioimpedance guided management on final health outcomes.ConclusionsMultiple frequency bioimpedance testing may offer a cost-effective approach to improve fluid management in patients with CKD on dialysis, but further research would be of value to reduce the current uncertainties.

AB - AbstractBackgroundAmong people with chronic kidney disease (CKD) on dialysis, sub-optimal fluid management has been linked with hospitalisation, cardiovascular complications and death. This study assessed the cost-effectiveness using multiple-frequency bioimpedance guided fluid management versus standard fluid management based on clinical judgment.MethodsA Markov model was developed to compare expected costs, outcomes and quality adjusted life years of the alternative management strategies. The relative effectiveness of the bioimpedance guided approach was informed by a systematic review of clinical trials, and focussed reviews were conducted to identify baseline event rates, costs and health state utility values for application in the model. The model was analysed probabilistically and a value of information (VOI) analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base.ResultsFor the base-case analysis, the incremental cost-effectiveness ratio (ICER) for bioimpedance guided fluid management versus standard management was £16,536 per QALY gained. There was a 59% chance of the ICER being below £20,000 per QALY. Form the VOI analysis, the theoretical upper bound on the value of further research was £53 million. The value of further research was highest for parameters relating to the relative effectiveness of bioimpedance guided management on final health outcomes.ConclusionsMultiple frequency bioimpedance testing may offer a cost-effective approach to improve fluid management in patients with CKD on dialysis, but further research would be of value to reduce the current uncertainties.

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KW - BCM-Body Composition Monitor

KW - Cost-effectiveness

KW - Value of information analysis

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Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis

Abstract

Bibliographical note

Keywords

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