Long-term cost-effectiveness of CKD screening in middle-aged adults

Chronic kidney disease (CKD) is common in Finland and frequently remains undiagnosed until advanced stages. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) slow CKD progression and reduce cardio-renal events when used in addition to Renin-Angiotensin-Aldosterone System inhibitor (RAASi) treatment. We hypothesized that a one-time CKD screening program using measurements of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), followed by SGLT2i and RAASi treatment for identified CKD, would be cost-effective in Finland.

We developed a cohort-based Markov model to simulate lifetime CKD progression in a Finnish cohort aged 55 years under two strategies: (1) current practice (no screening) and (2) one-time screening with follow-up and SGLT2i and RAASi treatment for screen-positive CKD (eGFR <60 mL/min/1.73 m² and/or UACR ≥3 mg/mmol; confirmed on a repeat sample after ≥ 3 months to establish chronicity). All CKD stages (G1-G5, dialysis, transplant, and death) were included in the model, and screening could detect CKD at any stage, although the incremental detection was concentrated in earlier, previously undiagnosed stages (G1-G3). Outcomes included discounted costs, quality-adjusted life years (QALYs), life years, and clinical outcomes (acute kidney function decline, heart-failure hospital days, dialysis and transplant patient-years, and deaths). Results are reported as means with 95% confidence intervals (CI).

Screening increased discounted lifetime costs per person by €907 (95% CI €334-2 553) and QALYs by 0.14 (95% CI 0.07-0.31), yielding an incremental cost-effectiveness ratio of €6 478/QALY. Screening increased life years by 0.30. Screening reduced acute kidney function decline (0.88 vs 0.90 events/person), heart-failure hospital days (6.47 vs 6.69 days/person), dialysis exposure (0.29 vs 0.32 patient-years/person) and transplant exposure (0.13 vs 0.14 patient-years/person).

In Finns aged 55 years, one-time CKD screening with eGFR/UACR followed by SGLT2i and RAASi treatment improves long-term outcomes and is likely cost-effective.