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

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

3. 3

4. 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. Definition 4

5. 5 Guise JM and Viswanathan M, Clinical pharmacology & Therapeutics 90, 876 (2011)

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

7. Standard Treatment Alternative Clone 1 BioSignature Probability 1 Clone 2 Probability 2 C2 p1 p2 Outcme 1 Outcome 2 Outcme 1 Clone 2 C2 C1 Probability 1 p1 p2 Outcome 2 Probability 2 Outcme 1 BIOMARKERS 7

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

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