dc.contributor.author
Parikh, Amay
dc.contributor.author
Rizzo, John A.
dc.contributor.author
Canetta, Pietro
dc.contributor.author
Forster, Catherine
dc.contributor.author
Sise, Meghan
dc.contributor.author
Maarouf, Omar
dc.contributor.author
Singer, Eugenia
dc.contributor.author
Elger, Antje
dc.contributor.author
Elitok, Saban
dc.contributor.author
Schmidt-Ott, Kai
dc.contributor.author
Barasch, Jonathon
dc.contributor.author
Nickolas, Thomas L.
dc.date.accessioned
2018-06-08T11:12:33Z
dc.date.available
2017-06-09T12:02:44.242Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/21808
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-25096
dc.description.abstract
Introduction Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a
sensitive and specific diagnostic test for acute kidney injury (AKI) in the
Emergency Department (ED), but its economic impact has not been investigated.
We hypothesized that uNGAL used in combination with serum creatinine (sCr)
would reduce costs in the management of AKI in patients presenting to the ED
in comparison to using sCr alone. Materials and methods A cost simulation
model was developed for clinical algorithms to diagnose AKI based on sCr alone
vs. uNGAL plus sCr (uNGAL+sCr). A cost minimization analysis was performed to
determine total expected costs for patients with AKI. uNGAL test
characteristics were validated with eight-hundred forty-nine patients with sCr
≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S.
hospitals from 2007–8. Biomarker test, AKI work-up, and diagnostic imaging
costs were incorporated. Results For a hypothetical cohort of 10,000 patients,
the model predicted that the expected costs were $900 per patient (pp) in the
sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer
patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436
pts) at center 1 and 1,973 fewer patients with delayed diagnosis and treatment
than sCr alone at center 2 (2,227 vs. 254 patients). Although initial
evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total
costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to
expected reduced delays in diagnosis and treatment. Sensitivity analyses
confirmed savings with uNGAL + sCr for a range of cost inputs. Discussion
Using uNGAL with sCr as a clinical diagnostic test for AKI may improve patient
management and reduce expected costs. Any cost savings would likely result
from avoiding delays in diagnosis and treatment and from avoidance of
unnecessary testing in patients given a false positive AKI diagnosis by use of
sCr alone.
de
dc.rights.uri
http://creativecommons.org/licenses/by/4.0/
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit
dc.title
Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum
creatinine (sCr) for acute kidney injury (AKI) diagnosis
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation
PLoS ONE. - 12 (2017), 5, Artikel Nr. e0178091
dcterms.bibliographicCitation.doi
10.1371/journal.pone.0178091
dcterms.bibliographicCitation.url
http://doi.org/10.1371/journal.pone.0178091
refubium.affiliation
Charité - Universitätsmedizin Berlin
de
refubium.mycore.fudocsId
FUDOCS_document_000000027160
refubium.note.author
Der Artikel wurde in einer reinen Open-Access-Zeitschrift publiziert.
refubium.resourceType.isindependentpub
no
refubium.mycore.derivateId
FUDOCS_derivate_000000008304
dcterms.accessRights.openaire
open access