DyeVer PLUS EZ system for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Diagnostic Coronary Angiography and/or Percutaneous Coronary Intervention: A UK-Based Cost-Utility Analysis

Background: Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall injected contrast media and aortic reflux and potentially improving long-term health outcomes. Objectives: To assess the long-term costs and health outcomes associated with the introduction of the DyeVert PLUS EZ system into the health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3-4 undergoing Diagnostic Coronary Angiography (DAG) and/or Percutaneous Coronary intervention (PCI), compared with current practice. Methods: A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert, in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results. Results: Base-case results indicate that the intervention leads to cost savings (- 3,878) and improved effectiveness (+ 0.02 QALYs) over the patients lifetime, compared with current practice. Output from the probabilistic analysis supports the high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall long-term cost saving for the NHS associated with introduction of the intervention for each cohort of patients is over 175 million. The cost savings are mainly driven by lower risk of subsequent diseases and associated costs Conclusions: Introduction of the DyeVer PLUS EZ system has the potential to reduce costs for the health care service and lead to improved clinical outcomes for patients with CKD stage 3-4 undergoing angiographic procedures.