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

What can we do more for the cost-effectiveness of management of AKI?. 鄭昌錡 20120321. Phases of clinical biomarker evaluation and AKI studies. Siew ED, et al. JASN 2011. Comparative effectiveness research (CER) 比較效果研究. Definition.

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

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

  2. Phases of clinical biomarker evaluation and AKI studies Siew ED, et al. JASN 2011

  3. Comparative effectiveness research (CER) 比較效果研究

  4. Definition 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.

  5. GuiseJM and ViswanathanM, Clinical pharmacology & Therapeutics 90, 876 (2011)

  6. Decision Tree Outcome1 Outcome2 Clone 1 StandardTreatment Probability 1 Outcome2 C1 Outcome1 Outcome1 p1 Probability 2 p2 Clone 2 Outcome2 Outcome2 C2 Outcome2 C1 Outcome1 p1 Clone 1 AVERAGE OUTCOMES Life years (LY), QALY,… Average costs Probability 1 p2 Alternative Outcome2 C2 Clone 2 Outcome1 Probability 2

  7. BioSignature Clone 1 StandardTreatment Probability 1 C1 Outcme1 p1 Probability 2 p2 Clone 2 BIOMARKERS Outcome2 C2 Outcme1 p1 Clone 1 Probability 1 p2 Alternative Outcome2 C2 Clone 2 Outcme1 Probability 2

  8. Novel biomarkers in AKI Parikh CR et al. CCM 2008 Chen YC, Fang JT, Yang CW. Taiwan Crit Care Med 2009

  9. Recovery Apply into Cardiorenal syndrome CKD Intervention ESRD on RRT AKI Mortality Recovery AHF AKI biomarkers SMT CKD Survive AMI BNP Pro-BNP Cardiac echo ESRD on RRT Non-AKI Mortality Mortality Survive Recovery Non-HF CKD Cardiac enzymes CXR ECG CCU Mortality Intervention ESRD on RRT (n>1000) AKI Mortality Recovery AHF AKI biomarkers SMT CKD Survive ESRD on RRT BNP Pro-BNP Cardiac echo Non-AKI Mortality Mortality Non-AMI Survive Non-HF Mortality PS. AKI patients >300, Mortality patients >90

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