Cost-Utility Analysis of Accelerated and Standard Strategies for Renal Replacement Therapy Initiation
Authors' conclusion
The findings of this economic evaluation suggest that standard KRT initiation may be cost-effective in a Canadian setting, but this finding was sensitive to postdischarge cost trajectories and regional variation in KRT dependence.
Study context
- Population
- Critically ill patients with severe acute kidney injury (AKI) from the STARRT-AKI trial, linked to Alberta, Canada, health databases
- Participants
- 146 STARRT-AKI trial patients
- Comparison
- Standard vs accelerated kidney replacement therapy (KRT) initiation
- Accelerated initiationn = 73reference
- Standard initiationn = 73
- Primary endpoint
- Cost per quality-adjusted life-year (QALY) gained
Methodological details5000 Monte Carlo simulations, linked administrative health databases (Alberta, Canada), multicentre, multinational trial data, Model health states: no CKD, severe CKD, KRT dependent, dead, Trial conducted October 2015 to September 2019; data analysed February 2022 to November 2024
- 5000 Monte Carlo simulations
- Linked administrative health databases (Alberta, Canada)
- Multicentre, multinational trial data
- Model health states: no CKD, severe CKD, KRT dependent, dead
- Trial conducted October 2015 to September 2019; data analysed February 2022 to November 2024
Primary result
As reported in the abstract
Cost per QALY gained
Incremental cost-effectiveness ratio (ICER)
$23 208 2024 Canadian dollars per QALY
Cost per quality-adjusted life-year (QALY) gained
Incremental net monetary benefit (INMB)
$22 648 2024 Canadian dollars (95% CrI $15 980-$29 316)
willingness to pay per QALY of $50 000
Further findings
QALYs
| Outcome | Accelerated initiation | Standard initiation |
|---|---|---|
| Cost per patient | mean $231 518 (SD $183 302) 2024 Canadian dollars | mean $251 370 (SD $155 801) 2024 Canadian dollars |
Original publication
Cost-Utility Analysis of Accelerated and Standard Strategies for Renal Replacement Therapy Initiation. JAMA Netw Open. Published 1 October 2025. doi:10.
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