Abstract
BackgroundBetter treatment during early stages of chronic kidney disease (CKD) may slow progression to end-stage renal disease and decrease associated complications and medical costs. Achieving early treatment of CKD is challenging, however, because a large fraction of persons with CKD are unaware of having this disease. Screening for CKD is one important method for increasing awareness. We examined the cost-effectiveness of identifying persons for early-stage CKD screening (i.e., screening for moderate albuminuria) using published CKD risk scores.MethodsWe used the CKD Health Policy Model, a micro-simulation model, to simulate the cost-effectiveness of using CKD two published risk scores by Bang et al. and Kshirsagar et al. to identify persons in the US for CKD screening with testing for albuminuria. Alternative risk score thresholds were tested (0.20, 0.15, 0.10, 0.05, and 0.02) above which persons were assigned to receive screening at alternative intervals (1-, 2-, and 5-year) for follow-up screening if the first screening was negative. We examined incremental cost-effectiveness ratios (ICERs), incremental lifetime costs divided by incremental lifetime QALYs, relative to the next higher screening threshold to assess cost-effectiveness. Cost-effective scenarios were determined as those with ICERs less than $50,000 per QALY. Among the cost-effective scenarios, the optimal scenario was determined as the one that resulted in the highest lifetime QALYs.ResultsICERs ranged from $8,823 per QALY to $124,626 per QALY for the Bang et al. risk score and $6,342 per QALY to $405,861 per QALY for the Kshirsagar et al. risk score. The Bang et al. risk score with a threshold of 0.02 and 2-year follow-up screening was found to be optimal because it had an ICER less than $50,000 per QALY and resulted in the highest lifetime QALYs.ConclusionsThis study indicates that using these CKD risk scores may allow clinicians to cost-effectively identify a broader population for CKD screening with testing for albuminuria and potentially detect people with CKD at earlier stages of the disease than current approaches of screening only persons with diabetes or hypertension.
Highlights
Better treatment during early stages of chronic kidney disease (CKD) may slow progression to endstage renal disease and decrease associated complications and medical costs
Sensitivity analysis To test the sensitivity of our results and conclusions to the choice of parameters for risks and costs, we conducted a number of one-way sensitivity analyses by varying key model parameters by ±25%: the hazard ratio of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blockers (ARBs) treatment on transition from moderate to severe albuminuria, the hazard ratio of ACE inhibitor/ARB treatment on estimated glomerular filtration rates (eGFR) decline, the hazard ratio of ACE inhibitor/ARB treatment on the annual mortality rate, ACE inhibitor inhibitor/ARB adherence, the costs of screening, and the costs of ACE inhibitor/ARB treatment
We examined the Incremental cost-effectiveness ratios (ICER) relative to the no screening scenario and determined the percentage change from results in the main analysis
Summary
Better treatment during early stages of chronic kidney disease (CKD) may slow progression to endstage renal disease and decrease associated complications and medical costs. We examined the cost-effectiveness of identifying persons for early-stage CKD screening (i.e., screening for moderate albuminuria) using published CKD risk scores. Identifying costeffective methods of screening for CKD in other populations is crucial to increase awareness of CKD and CKD screening among patients and clinicians and to improve early detection and management of CKD. Using CKD risk scores to identify persons for CKD screening with testing for albuminuria may prove to be a cost-effective method for identifying a population broader than just those with diabetes or hypertension. We used the CKD Health Policy Model, a microsimulation model of CKD progression, to examine the costeffectiveness of identifying persons for early-stage CKD screening (i.e., screening for moderate albuminuria) using two published CKD risk scores: one published by Bang et al [15] and one published by Kshirsagar et al [16]. We assessed the cost-effectiveness of alternative screening scenarios by varying risk score thresholds above which persons were assigned to receive screening and frequencies of follow-up screening if the initial test was negative
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