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Am J Kidney Dis. 2014 May;63(5):789-97. doi: 10.1053/j.ajkd.2013.12.012. Epub 2014 Feb 12.

Cost-effectiveness of primary screening for CKD: a systematic review.

Author information

  • 1Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada. Electronic address: paulkomenda@yahoo.com.
  • 2Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
  • 3Department of Library Services, University of Manitoba, Winnipeg, Canada.
  • 4Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
  • 5Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.

Abstract

BACKGROUND:

Chronic kidney disease (CKD) is a major health problem with an increasing incidence worldwide. Data on the cost-effectiveness of CKD screening in the general population have been conflicting.

STUDY DESIGN:

Systematic review.

SETTING & POPULATION:

General, hypertensive, and diabetic populations. No restriction on setting.

SELECTION CRITERIA FOR STUDIES:

Studies that evaluated the cost-effectiveness of screening for CKD.

INTERVENTION:

Screening for CKD by proteinuria or estimated glomerular filtration rate (eGFR).

OUTCOMES:

Incremental cost-effectiveness ratio of screening by proteinuria or eGFR compared with either no screening or usual care.

RESULTS:

9 studies met criteria for inclusion. 8 studies evaluated the cost-effectiveness of proteinuria screening and 2 evaluated screening with eGFR. For proteinuria screening, incremental cost-effectiveness ratios ranged from $14,063-$160,018/quality-adjusted life-year (QALY) in the general population, $5,298-$54,943/QALY in the diabetic population, and $23,028-$73,939/QALY in the hypertensive population. For eGFR screening, one study reported a cost of $23,680/QALY in the diabetic population and the range across the 2 studies was $100,253-$109,912/QALY in the general population. The incidence of CKD, rate of progression, and effectiveness of drug therapy were major drivers of cost-effectiveness.

LIMITATIONS:

Few studies evaluated screening by eGFR. Performance of a quantitative meta-analysis on influential assumptions was not conducted because of few available studies and heterogeneity in model designs.

CONCLUSIONS:

Screening for CKD is suggested to be cost-effective in patients with diabetes and hypertension. CKD screening may be cost-effective in populations with higher incidences of CKD, rapid rates of progression, and more effective drug therapy.

Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Cost-effectiveness analysis; chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR); incremental cost-effectiveness ratio (ICER); proteinuria; public health screening; risk stratification

PMID:
24529536
[PubMed - indexed for MEDLINE]
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