PUK22 HEALTH ECONOMIC ASPECTS OF USING SERUM CYSTATIN C FOR EARLY DETECTION OF CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETICS IN GERMANY

Abstract

CONTACT: Dr. Evelyn Walter IPF Institute for Pharmaeconomic Research Wolfgengasse 4/7 1010 Vienna, Austria Tel +43-1-5132007-13 Fax +43-1-5132007-15 Email: e.walter@ipf-ac.at Web: www.ipf-ac.at Objectives Diabetic nephropathy is a serious and common complication in diabetic patients. However the onset and the course of the diabetic nephropathy can be favourably influenced by appropriate therapy when detected early. In 2004 the independent international Kidney Disease Improving Global Outcome Organisation (KDIGO) recommended 2 laboratory tests for an early detection of chronic kidney disease (CKD): determination of serum creatinine to estimate glomerular filtration rate (eGFR) using the simplified equation derived from the Modification of Diet in Renal Disease Study (MDRD) and determination of proteinuria preferably microalbuminuria corrected for urine creatinine. Creatinine as a marker for eGFR has metabolic and technical limitations, especially in patients with only mild impairment of kidney function. As an alternative marker serum Cystatin C (CysC) has been proposed for early detection of CKD. Methods We developed a cost-utility-model to simulate the long-term consequences of diabetic nephropathy using CysC instead of creatinine to monitor renal function. Markov-modelling-techniques were used to describe complications and disease progression; one arm assessed the costs and effects of CysC reporting, disease progression and complications, and the other assessed the cost and effect of routine eGFR reporting. Probabilities of complications were derived from clinical and epidemiological studies. The model includes eleven a priori defined health states to describe the disease progression and occurrence of adverse events. Disease progression leads to a passover to the next health state; the others remain. The Markov-cycle length is one year.