Paul Komenda1, Thomas W Ferguson2, Kerry Macdonald3, Claudio Rigatto4, Chris Koolage2, Manish M Sood5, Navdeep Tangri4. 1. Section 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. 2. Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada. 3. Department of Library Services, University of Manitoba, Winnipeg, Canada. 4. Section 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. 5. Ottawa 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.
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.
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