Early Bayesian modeling of a potassium lab-on-a-chip for monitoring of heart failure patients at increased risk of hyperkalaemia.

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Wetering, G. van de and Steuten, L.M.G. and Birgelen, C. von and Adang, E.M. and IJzerman, M.J. (2012) Early Bayesian modeling of a potassium lab-on-a-chip for monitoring of heart failure patients at increased risk of hyperkalaemia. Technological forecasting and social change, 79 (7). 1268 - 1279. ISSN 0040-1625

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Abstract:Objectives: Innovative point-of-care (POC) diagnostics are likely to have a strong impact on 18 health care. The aim of this study is to conduct an early assessment of a point-of-care chip 19 for the detection of a pathological deviation of the potassium levels in patients at increased 20 risk, specifically in patients with heart failure (HF) requiring diuretics and ACE inhibitors that 21 can both interfere with potassium levels, which may lead to serious clinical complications. This 22 study also identifies the key factors that determine the success of the application under study. 23 Methods: AMarkov health state transitionmodelwas developed representing the disease process. 24
Model parameters were obtained from various literature sources and estimated using interviews 25 and related data. Simulationwas carried out for 60 cycles of 1 month each. A discount rate of 3.5% 26 was used, both for costs and utilities. In order to assess uncertainty a probabilistic sensitivity anal- 27
ysis was carried out from which a cost-effectiveness acceptability curve was derived. 28 Results: For an anticipated number of 121 measurements per year with a cost of €16.60 per chip, 29 an incremental cost-effectiveness ratio (ICER) of 34,856 €/QALY was found. Sensitivity analysis 30
revealed that the threshold for the costs per chip was €19.30 in order to maintain a positive 31 net monetary benefit. Also, model results are very sensitive to the utility of hyperkalaemia and 32 to the probability to develop severe hyperkalaemia. 33 Conclusions: The question whether or not a POC chip to measure potassium concentrations in 34 order to avoid a severe potassium imbalance is likely to be cost-effective cannot be definitively 35 answered with the information at our disposal. Further research should focus on heart HF 36 patients at particularly high risk of severe life-threatening hyperkalaemia, for instance in the 37 presence of significant renal dysfunction. It may be expected that the use of the chip in such 38 patient populations may render this point-of-care application very cost-effective
Item Type:Article
Copyright:© Elsevier
Faculty:
Management and Governance (SMG)
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Link to this item:http://purl.utwente.nl/publications/79807
Official URL:http://dx.doi.org/10.1016/j.techfore.2012.02.004
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