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Population based screening for chronic kidney disease: cost effectiveness study.

Braden Manns1, Brenda Hemmelgarn, Marcello Tonelli

  • 1Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Braden.Manns@albertahealthservices.ca

BMJ (Clinical Research Ed.)
|November 10, 2010
PubMed
Summary

Population-based screening for chronic kidney disease (CKD) using estimated glomerular filtration rate (eGFR) is not cost-effective overall. However, targeted CKD screening in individuals with diabetes shows a cost-effectiveness comparable to other funded healthcare interventions.

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Area of Science:

  • Nephrology
  • Public Health
  • Health Economics

Background:

  • Chronic kidney disease (CKD) poses a significant public health challenge.
  • Early detection through screening can potentially mitigate disease progression and reduce long-term healthcare costs.
  • Estimated glomerular filtration rate (eGFR) is a key biomarker for assessing kidney function.

Purpose of the Study:

  • To evaluate the cost-effectiveness of a one-off, population-based screening program for CKD using eGFR.
  • To compare the costs and health outcomes of eGFR screening versus no screening within a publicly funded healthcare system.

Main Methods:

  • A cost-utility analysis was conducted, comparing eGFR screening to a no-screening strategy.
  • Analyses stratified participants by age, diabetes status, and presence of proteinuria.
  • A large, population-based laboratory cohort was used to estimate mortality and end-stage renal disease (ESRD) incidence over five years.

Main Results:

  • Overall, CKD screening yielded an incremental cost of C$463 and a gain of 0.0044 QALYs per patient, resulting in a cost per QALY of C$104,900.
  • Screening 100,000 individuals was projected to decrease lifetime ESRD incidence from 675 to 657.
  • For individuals with diabetes, the cost per QALY gained was C$22,600, while for those without diabetes, it was C$572,000 (with hypertension) and C$1,411,100 (without hypertension).

Conclusions:

  • Population-based CKD screening using eGFR is not cost-effective for the general population, older individuals, or those with hypertension.
  • Targeted screening for CKD in individuals with diabetes demonstrates a cost-effectiveness ratio (C$22,600 per QALY) that aligns with established benchmarks for publicly funded healthcare interventions.