Original Investigation
Pathogenesis and Treatment of Kidney Disease
Cost-effectiveness of Primary Screening for CKD: A Systematic Review

https://doi.org/10.1053/j.ajkd.2013.12.012Get rights and content

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.

Section snippets

Data Sources and Searches

We identified studies evaluating the cost-effectiveness of population-based screening for CKD in the general population and in patients with diabetes and hypertension. The studies included had to report an incremental cost-effectiveness ratio (ICER) of screening strategies based on estimated glomerular filtration rate (eGFR; serum creatinine) or proteinuria (proteinuria or microalbuminuria) in comparison to no screening or usual care.

We retrieved information for the study from the following

Study Selection

A flow diagram outlining the selection strategy is shown in Fig 1. Our initial search strategy retrieved 1,462 citations for screening. Of these, 161 articles were selected for full-text review, and 9 studies9, 10, 11, 12, 13, 14, 15, 16, 17 (1 of which was covered by 2 publications10, 11) met criteria for inclusion in the review.

Characteristics of Selected Studies

Eight studies evaluated the cost-effectiveness of proteinuria-based screening. Four focused on microalbuminuria9, 10, 11, 12, 13 and 4 focused on dipstick proteinuria.

Discussion

Our systematic review found that screening for CKD by eGFR and/or albuminuria in high-risk populations (those with diabetes or hypertension) was suggested to be cost-effective (<$50,000/QALY).10, 11, 12, 13, 14, 15, 17 In contrast, screening was not cost-effective in the general population, except in situations in which screening could be added to mandatory health checkups16 or rates of CKD progression were rapid and RAAS inhibitors could be considered highly effective for renal and

Acknowledgements

Support: Dr Sood receives funding from the Jindal Chair in Kidney Research. Dr Tangri is supported by the KRESCENT New Investigator Award (a joint initiative of the Kidney Foundation of Canada, the Canadian Institute of Health Research, and the Canadian Society of Nephrology).

Financial Disclosure: The authors declare that they have no other relevant financial interests.

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    Because the Editor-in-Chief recused himself from consideration of this manuscript, the Deputy Editor (Daniel E. Weiner, MD, MS) served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Information for Authors & Editorial Policies.

    P.K. and T.W.F. contributed equally to this work.

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