What can we do more for the cost-effectiveness of management of AKI? 鄭昌錡 20120321 1

What can we do more for the cost-effectiveness of management of

AKI?鄭昌錡

20120321

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Siew ED, et al. JASN 2011

Phases of clinical Phases of clinical biomarker evaluation biomarker evaluation and AKI studies and AKI studies

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The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, or to improve the delivery of care.

Definition

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Guise JM and Viswanathan M, Clinical pharmacology & Therapeutics 90, 876 (2011)

StandardTreatment

Alternative

Clone 1

Clone 2

C2

C1

Decision Tree

Probability 1

p1

p2

AVERAGE OUTCOMES

Life years (LY), QALY,…

Average costs

Outcome2

Probability 2

Clone 1

Probability 1

Clone 2

Probability 2

C2

C1

p1

p2

OutcomeOutcome11

Outcome2

Outcome1Outcome1

OutcomeOutcome11

Outcome2

Outcome2

Outcome2

Outcome2

OutcomeOutcome11

OutcomeOutcome11

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StandardTreatment

Alternative

Clone 1

BioSignatureBioSignature

Clone 1

Probability 1

Clone 2

Probability 2

C2

p1

p2

OutcmeOutcme11

Outcome2

OutcmeOutcme11

Clone 2

C2

C1Probability 1

p1

p2Outcome2

Probability 2

OutcmeOutcme11

BIOMARKERSBIOMARKERS

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Novel biomarkers in AKI

Parikh CR et al. CCM 2008Chen YC, Fang JT, Yang CW. Taiwan Crit Care Med 2009

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CCU

AMI

(n>1000)

Non-AMI

Cardiac enzymesCXRECG

AHF

Non-HF

Non-HF

AHF

Mortality

Survive

Survive

Apply into Cardiorenal syndrome

BNPPro-BNPCardiac echo

BNPPro-BNPCardiac echo

AKI biomarkersAKI biomarkers

AKI biomarkersAKI biomarkers

AKI

AKI

Non-AKI

Non-AKI

SMT

Survive

Mortality

Survive

Mortality

Intervention

SMT

Recovery

Recovery

Recovery

Recovery

Mortality

Mortality

Mortality

Mortality

CKD

CKD

CKD

CKD

ESRD on RRT

ESRD on RRT

ESRD on RRT

ESRD on RRT

PS. AKI patients >300, Mortality patients >90

Mortality

Intervention

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