Population-Wide Screening for Chronic Kidney Disease : A Cost-Effectiveness Analysis

Area of Science:

• Nephrology
• Public Health
• Health Economics

Background:

• Chronic kidney disease (CKD) affects a significant population, and its progression can be altered by novel therapies.
• Sodium-glucose cotransporter-2 (SGLT2) inhibitors represent a promising therapeutic class for managing CKD.
• Cost-effectiveness analyses are crucial for evaluating the integration of new screening and treatment strategies into healthcare.

Purpose of the Study:

• To assess the cost-effectiveness of implementing population-wide screening for CKD in adults.
• To evaluate the added value of incorporating SGLT2 inhibitors into CKD screening protocols.
• To determine optimal screening frequencies and age ranges for maximizing health gains.

Main Methods:

• A Markov cohort model was utilized to simulate disease progression and healthcare costs over a lifetime horizon.
• Data from NHANES, Medicare, cohort studies, and the DAPA-CKD trial informed the model parameters.
• Cost-effectiveness was measured using incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained.

Main Results:

• One-time CKD screening at age 55 yielded an ICER of $86,300 per QALY gained, increasing life expectancy and reducing kidney failure incidence.
• Screening between ages 35-75 prevented dialysis or transplant in 398,000 individuals; biennial screening cost <$100,000 per QALY.
• Sensitivity analyses indicated that SGLT2 inhibitor price reductions may be necessary if their efficacy is lower than observed.

Conclusions:

• Screening adults for albuminuria to detect CKD is a cost-effective strategy in the United States.
• The inclusion of SGLT2 inhibitors in CKD management pathways warrants further cost-effectiveness consideration.
• Optimizing screening protocols can lead to substantial improvements in patient outcomes and healthcare resource utilization.