Population based screening for chronic kidney disease: cost effectiveness study

Abstract

Objective To determine the cost effectiveness of one-off population based screening for chronic kidney disease based on estimated glomerular filtration rate.Design Cost utility analysis of screening with estimated glomerular filtration rate alone compared with no screening (with allowance for incidental finding of cases of chronic kidney disease). Analyses were stratified by age, diabetes, and the presence or absence of proteinuria. Scenario and sensitivity analyses, including probabilistic sensitivity analysis, were performed. Costs were estimated in all adults and in subgroups defined by age, diabetes, and hypertension.Setting Publicly funded Canadian healthcare system.Participants Large population based laboratory cohort used to estimate mortality rates and incidence of end stage renal disease for patients with chronic kidney disease over a five year follow-up period. Patients had not previously undergone assessment of glomerular filtration rate. Main outcome measures Lifetime costs, end stage renal disease, quality adjusted life years (QALYs) gained, and incremental cost per QALY gained.Results Compared with no screening, population based screening for chronic kidney disease was associated with an incremental cost of $C463 (Canadian dollars in 2009; equivalent to about £275, €308, US $382) and a gain of 0.0044 QALYs per patient overall, representing a cost per QALY gained of $C104 900. In a cohort of 100 000 people, screening for chronic kidney disease would be expected to reduce the number of people who develop end stage renal disease over their lifetime from 675 to 657. In subgroups of people with and without diabetes, the cost per QALY gained was $C22 600 and $C572 000, respectively. In a cohort of 100 000 people with diabetes, screening would be expected to reduce the number of people who develop end stage renal disease over their lifetime from 1796 to 1741. In people without diabetes with and without hypertension, the cost per QALY gained was $C334 000 and $C1 411 100, respectively.Conclusions Population based screening for chronic kidney disease with assessment of estimated glomerular filtration rate is not cost effective overall or in subgroups of people with hypertension or older people. Targeted screening of people with diabetes is associated with a cost per QALY that is similar to that accepted in other interventions funded by public healthcare systems.

Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka

“…These values are almost double those reported by Manns et al [14], who showed that the probability of death in a CKD cohort in Alberta, Canada, was 4.81% for patients aged \66 years and 13.29% for those aged [65 years. It is particularly interesting to note that 81% of the Canadian cohort had CKD stage 1 or 2, 18% had stage 3, and 1% had stage 4 or 5, whereas in our cohort, 50% had stage 1 or 2, 22% had stage 3, and 28% had stage 4 or 5.…”

Risk Prediction for Early CKD in Type 2 Diabetes

“…Because unselective screening for kidney disease is not cost-effective (3,4), stratification of people at risk for CKD or progression of CKD is urgently needed in analogy to the highly successful risk calculators in the area of cardiovascular medicine (5). In people with diabetes, for example, screening for established CKD with measurements of albuminuria and eGFR has been shown to be cost-effective, with estimated costs of $18,650 (2009) per quality-adjusted life-year gained (6). Because primary prevention strategies are likely to be most cost-effective (6), it is also desirable to predict incident CKD in people with diabetes before microalbuminuria develops and CKD progression in those with microalbuminuria.…”

“…In people with diabetes, for example, screening for established CKD with measurements of albuminuria and eGFR has been shown to be cost-effective, with estimated costs of $18,650 (2009) per quality-adjusted life-year gained (6). Because primary prevention strategies are likely to be most cost-effective (6), it is also desirable to predict incident CKD in people with diabetes before microalbuminuria develops and CKD progression in those with microalbuminuria.…”

Adding Specialized Clinics for Remote-Dwellers with Chronic Kidney Disease

“…Estimates were adjusted for age, sex, aboriginal status (registered First Nations and recognized Inuit), baseline GFR, social assistance, low-income subsidy, DM cause of CKD, and comorbidities (hypertension, DM, cancer, cardiovascular disease, myocardial infarction, heart failure, COPD, dementia, HIV/AIDS, liver disease, paraplegia, peptic ulcer disease, peripheral vascular disease, rheumatic disease). Estimates for transplantation, graft failure, and mortality in RRT states were drawn from our previous work in a similar dataset (Table 3) (16).…”