Cost-effectiveness of screening for chronic kidney disease using a cumulative eGFR-based statistic

Area of Science:

• Nephrology
• Health Economics
• Preventive Medicine

Background:

• Chronic kidney disease (CKD) screening lacks established guidelines, hindering timely interventions.
• Early detection of CKD is crucial for slowing disease progression and preventing complications.

Purpose of the Study:

• To evaluate the cost-effectiveness of CKD screening using a novel cumulative sum statistic of estimated glomerular filtration rate (CUSUMGFR).
• To compare various CUSUMGFR-based screening strategies against the status quo.

Main Methods:

• A microsimulation model was developed to simulate CKD progression, complications, and treatment adherence in a US cohort (age ≥ 30).
• Evaluated universal screening (annual/biennial, starting at 30/60) and targeted screening (hypertension, diabetes) using CUSUMGFR.
• Assessed disability-adjusted life years (DALYs) and direct health costs, calculating incremental cost-effectiveness ratios (ICERs).

Main Results:

• All CUSUMGFR-based screening policies demonstrated cost-effectiveness within a willingness-to-pay (WTP) range of $50,000-$100,000.
• Universal annual screening from age 30 emerged as the most cost-effective non-dominated policy at a WTP of ~$25,000.
• Incorporating SGLT2 inhibitors was cost-saving; CKD progression rate, adherence, and testing costs were key sensitivity parameters.

Conclusions:

• CUSUMGFR-based CKD screening policies are highly cost-effective for early detection of end-stage kidney disease risk.
• The simplicity of CUSUMGFR, requiring only a basic blood test, facilitates its integration into clinical workflows for monitoring and prevention.