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

Area of Science:

• Nephrology
• Public Health
• Health Economics

Background:

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors have advanced chronic kidney disease (CKD) management.
• Population-wide CKD screening is now feasible, but optimal initiation age requires evaluation.

Purpose of the Study:

• To compare the clinical benefits, costs, and cost-effectiveness of population-wide CKD screening at various ages and frequencies.
• To determine the optimal age for initiating CKD screening in the general population.

Main Methods:

• A cost-effectiveness analysis using a Markov cohort model simulating CKD progression in US adults aged 35+.
• Data from NHANES, DAPA-CKD trial, and Medicare sources were utilized for calibration and effectiveness estimates.
• Screening strategies included albuminuria testing from age 35-75, with and without SGLT2 inhibitors, at different frequencies.

Main Results:

• Screening initiated at age 55 every 5 years, with SGLT2 inhibitors, reduced kidney failure incidence from 2.4% to 1.9% and increased life expectancy by 0.13 years, costing $128,400 per QALY gained.
• Earlier screening (ages 35 or 45) offered greater health benefits but exceeded $200,000 per QALY.
• Cost-effectiveness remained favorable for age 55 screening even with reduced SGLT2 inhibitor effectiveness or lower drug prices.

Conclusions:

• Initiating population-wide CKD screening at age 55 with SGLT2 inhibitors is cost-effective based on conventional medical benchmarks.
• This strategy represents a viable approach to improving CKD outcomes and managing healthcare resources effectively.