A Health Policy Model of CKD: 2. The Cost-Effectiveness of Microalbuminuria Screening
Received 28 April 2009; accepted 12 November 2009. published online 01 February 2010.
Refers to article:
The Map Is Not the Territory—Mapping Out the Course and Cost of CKD
Kevin C. Abbott, Cristina M. Yuan
American Journal of Kidney Diseases
March 2010 (Vol. 55, Issue 3, Pages 419-422) Full Text |
Full-Text PDF (675 KB)
Background
Microalbuminuria screening may detect chronic kidney disease in its early stages, allowing for treatment that delays or prevents disease progression. The cost-effectiveness of microalbuminuria screening has not been determined.
Study Design
A cost-effectiveness model simulating disease progression and costs.
Setting & Population
US patients.
Model, Perspective, and Timeframe
The microsimulation model follows up disease progression and costs in a cohort of simulated patients from age 50 to 90 years or death. Costs are evaluated from the health care system perspective.
Intervention
Microalbuminuria screening at 1-, 2-, 5-, or 10-year intervals followed by treatment with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We considered universal screening, as well as screening targeted at persons with diabetes, persons with hypertension but no diabetes, and persons with neither diabetes nor hypertension.
Outcomes
Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
Results
For the full model population, universal screening increases costs and increases QALYs. Universal annual screening starting at age 50 years has a cost-effectiveness ratio of $73,000/QALY relative to no screening and $145,000/QALY relative to usual care. Cost-effectiveness ratios improved with longer screening intervals. Relative to no screening, targeted annual screening has cost-effectiveness ratios of $21,000/QALY, $55,000/QALY, and $155,000/QALY for persons with diabetes, those with hypertension, and those with neither current diabetes nor current hypertension, respectively.
Limitations
Results necessarily are based on a microsimulation model because of the long time horizon appropriate for chronic kidney disease. The model includes only health care costs.
Conclusions
Microalbuminuria screening is cost-effective for patients with diabetes or hypertension, but is not cost-effective for patients with neither diabetes nor hypertension unless screening is conducted at longer intervals or as part of existing physician visits.
ABSTRACT