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Published on: June 30, 2018
Screening for proteinuria in US adults: a cost-effectiveness analysis
L Ebony Boulware1, Bernard G Jaar, Michelle E Tarver-Carr
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA. lboulwa@jhmi.edu
JAMA
|December 18, 2003
Summary
Screening adults for urine protein is not cost-effective for the general population. However, targeting individuals with hypertension or older adults, and infrequent screening intervals, improve cost-effectiveness for early chronic kidney disease detection.
Area of Science:
- Nephrology
- Public Health
- Health Economics
Background:
- Chronic kidney disease (CKD) presents a significant and increasing global health burden.
- Early CKD identification through screening may enhance patient outcomes but poses risks of overdiagnosis and increased healthcare expenditures.
Purpose of the Study:
- To evaluate the economic value of routine, population-wide dipstick screening for detecting early signs of proteinuria in adults.
- The study specifically assessed screening in adults without hypertension or diabetes, and in those with hypertension.
Main Methods:
- A cost-effectiveness analysis was performed using a Markov decision analytic model.
- The model compared annual proteinuria screening starting at age 50 with no screening (usual care).
- Treatment strategies included angiotensin-converting enzyme (ACE) inhibitors or angiotensin II-receptor blockers (ARBs).
Main Results:
- Screening adults without hypertension or diabetes was not cost-effective ($282,818 per QALY).
- Screening these individuals from age 60 improved cost-effectiveness ($53,372 per QALY).
- Screening adults with hypertension demonstrated high cost-effectiveness ($18,621 per QALY).
Conclusions:
- Routine proteinuria screening is not cost-effective for widespread population use.
- Selective screening of high-risk groups, including older adults and those with hypertension, is recommended.
- Infrequent screening (every 10 years) may enhance cost-effectiveness for broader populations.
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