Table 2 Deterministic cost-effectiveness scenario analyses for bioimpedance guided fluid management versus standard practice (excluding dialysis costs)
Strategy | Mean costs | Incremental costs | Mean QALYs | Incremental QALYs | ICER | Net monetary benefit (£) |
|---|---|---|---|---|---|---|
Base case: applying linked effects on mortality and non-fatal CV events, estimated through the pooled reduction in pulse wave velocity (HR of 0.9318 applied to both all-cause mortality and CV hospitalisation) | ||||||
  Standard care | £46,234 |  | 2.7014 |  |  | 7793 |
  BCM | £48,153 | £1919 | 2.8170 | 0.1157 | £16,587 | 8188 |
1. Alternative to base-case clinical effectiveness scenario: applying the point estimate for the pooled effect of BCM on non-fatal CV hospitalisation events only (through the pooled reduction in PWV (HR = 0.9318 on CV events only) | ||||||
  Standard care | £46,167 |  | 2.6976 |  |  | 7786 |
  BCM | £46,391 | £224 | 2.7032 | 0.0056 | £40,282 | 7673 |
2. Alternative to base-case clinical effectiveness scenario: applying the point estimate for the pooled effect of BCM on mortality only (through the pooled reduction in PWV) | ||||||
  Standard care | £46,234 |  | 2.7014 |  |  | 7793 |
  BCM | £55,579 | £9345 | 3.2719 | 0.5706 | £16,378 | 9859 |
3. Apply a 10% reduction in the use of blood pressure medications | ||||||
  Standard care | £46,234 |  | 2.7014 |  |  | 7793 |
  BCM | £48,090 | £1856 | 2.817 | 0.1157 | £16,044 | 8250 |
4. Apply an increased cost of monitoring in adults by increasing the number of tests per patient to 12 annually (£229.65) | ||||||
  Standard care | £46,234 |  | 2.7014 |  |  | 7793 |
  BCM | £48,774 | £2540 | 2.817 | 0.1157 | £21,953 | 7567 |
5. Assume bioimpedance guided management results in a 2% improvement in the health state utility over the lifetime of dialysis patients | ||||||
  Standard care | £46,234 |  | 2.7014 |  |  | 7793 |
  BCM | £48,153 | £1919 | 2.866 | 0.1646 | £11,656 | 9166 |
6. Applying a smaller effect on mortality and non-fatal CV events (HR = 0.95 for both) | ||||||
  Standard care | £46,234 |  | 2.7014 |  |  | 7793 |
  BCM | £47,757 | £1523 | 2.7853 | 0.084 | £18,135 | 7949 |
7. Applying a larger effect of bioimpedance monitoring on both CV events and mortality (0.844); consistent with the cross-sectional main effect of a unit change in PWV reported by Verbeke et al. [30] | ||||||
  Standard care | £46,234 |  | 2.7014 |  |  | 7793 |
  BCM | £50,163 | £3929 | 2.9791 | 0.2777 | £14,145 | 9419 |
8. Excluding all non-CV event-related causes of hospitalisation from the analysis | ||||||
  Standard care | £32,111 |  | 2.711 |  |  | 22,109 |
  BCM | £33,412 | £1,301 | 2.826 | 0.115 | £11,311 | 23,108 |