MO375: The Health Economic Impact of Accurately Diagnosing CKD With and Without a UACR Test at Different Points in the Pathway of Disease Progression

Abstract

Abstract BACKGROUND AND AIMS In the Kidney Disease Improving Global (KDIGO) guidelines, it is recommended that an accurate chronic kidney disease (CKD) diagnosis is based on repeated positive test results for estimated glomerular filtration rate (eGFR) and urine albumin-to-creatine ratio (UACR). While eGFR indicates kidney function decline, UACR identifies kidney damage, predicts CKD progression, and indicates risk for cardiovascular events. UACR testing is, therefore, a critical component of identifying CKD patients early. There is a lack of evidence that demonstrates the economic impact of early CKD diagnosis; hence, a cost-effectiveness model was built to demonstrate the potential clinical and economic benefit of undertaking UACR tests in those with early-stage CKD. METHOD The KDIGO heatmap quadrants were organised into a Markov model with three levels of severity (moderate, high, and very high CKD risk) over a lifetime horizon, for a cohort of 60-year-old patients in the base-case. Costs, life-years (LYs), quality adjusted life-years (QALYs), and the associated incremental cost-utility ratios (ICURs) were calculated (discounted at 3.5%). Costs consisted of testing, general practitioner (GP) visit, nephrologist visit, and treatment costs. Data inputs were based on published data from the literature and validated by clinicians. RESULTS Hypothetical comparisons between a 1000-patient cohort who had UACR tests undertaken in the early stages of CKD, predicted higher LYs and QALYS for patients in the KDIGO heatmap quadrants of G3aA1, G1A2, G2A2, G3aA2, G1A3, G2A3 and G3aA3 compared with a 1000-patient cohort who did not have UACR tests. By identifying individuals in the early stages of CKD, treatment can be initiated earlier, reducing the number of patients progressing to late-stage CKD and ultimately offsetting the more expensive treatment costs associated with late-stage CKD. Overall, ICURs for all quadrants were less than the UK's willingness to pay threshold of £20 000 per QALY. CONCLUSION Preliminary results suggest that undertaking regular UACR tests early in patients with CKD is a cost-effective strategy, as this allows an individual to initiate the appropriate treatment, resulting in slower disease progression. This is an important consideration for clinicians and policymakers due to the suboptimal UACR testing rates globally. Funding: Bayer AG