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Long-Term Healthcare Cost Savings of a Pediatric Nephrotoxic Medication-Associated Acute Kidney Injury Reduction
Linda Dynan1, Danielle Lazear2, Stuart L Goldstein3
1Department of Economics and Finance, Northern Kentucky University, Highland Heights, KY, USA.
Insights
The NINJA program significantly reduces healthcare costs by preventing acute kidney injury (AKI) and subsequent chronic kidney disease (CKD) in children. This pharmacist-led intervention demonstrates cost-effectiveness, offering substantial savings by mitigating long-term kidney complications.
Area of Science:
- Pediatric Nephrology
- Health Economics
- Clinical Pharmacy
Background:
- Nephrotoxic medication exposure is a primary cause of acute kidney injury (AKI) in hospitalized children, often leading to chronic kidney disease (CKD).
- The pharmacist-driven NINJA (Not In Nephrotoxic Agents) program has proven effective in reducing nephrotoxic medication exposure and associated AKI.
- Preventing AKI in pediatric patients is crucial for mitigating the long-term burden of CKD.
Purpose of the Study:
- To evaluate the potential healthcare cost savings associated with preventing chronic kidney disease (CKD) by implementing the NINJA program in a pediatric population up to age 21.
- To quantify the economic benefits of reducing AKI-related CKD through pharmacist intervention.
Main Methods:
- A simulated cohort of 1000 hospitalized non-critically ill children was analyzed.
- Data on AKI incidence, CKD development (10-70%), and estimated GFR decline rates (with and without hypertension) were used.
- Healthcare costs associated with CKD progression (medications, outpatient visits) were modeled, subtracting NINJA screening costs.
Main Results:
- Estimated CKD-related costs without intervention ranged from $761,852 to $5,735,027.
- Post-NINJA implementation, costs decreased, yielding net savings of $145,766 to $1,422,183.
- Total savings, including NINJA screening costs, ranged from -$110,914 to $1,165,503, indicating potential cost-benefit.
Conclusions:
- The NINJA program is likely cost-beneficial for preventing AKI and subsequent CKD in children.
- The intervention offers significant long-term savings by avoiding or delaying end-stage renal disease (ESRD).
- Pharmacist-led programs like NINJA are valuable in managing pediatric kidney health and reducing healthcare expenditures.
Abstract:
Background: Nephrotoxic medication exposure is a common cause of acute kidney injury (AKI) in hospitalized children and is associated with chronic kidney disease (CKD). The pharmacist-reliant NINJA program reduced nephrotoxic medication exposure and associated AKI. Objectives: We assess potential healthcare cost savings from reduced CKD by preventing AKI with the NINJA program for a pediatric population through age 21. Methods: We simulated a cohort of 1000 hospitalized non-critically ill children. From the published literature, 310 develop AKI, 267 survive to 6 months, and 10-70% develop CKD, and NINJA implementation reduced AKI by 23.8%. Allowing for varying CKD rates, we estimated a range of NINJA's savings. We assumed an annual GFR decline of 1.2 (noHTN) ml/min/1.73 m2 for half the sample and 1.7 (HTN) ml/min/1.73 m2 for the other half to account for CKD progression without and with hypertension (HTN). We model attributable costs including CKD stage-related medications and outpatient visits/tests in 2018 dollars discounted at 3%. We subtract the cost of NINJA screening (daily serum creatinine and pharmacist time) from net savings. We exclude end-stage renal disease (ESRD) and hospitalization costs. Results: No intervention estimated CKD related costs are $761,852 to $5,735,027. Post-NINJA cost decreases to $616,086 to $4,312,183 (net savings: $145,766 to $1,422 183). Total savings, accounting for NINJA screening ($256,680) are -$110,914 to $1,1 165 503. The breakeven AKI to CKD conversion rate is 13-14% with growth hormone cost included, and 64-65% without. Conclusion: The NINJA program is likely cost beneficial, with greater savings into adulthood by avoiding/delaying ESRD and its costs.
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