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Assessment of Kidney Function in Mouse Models of Glomerular Disease
Published on: June 30, 2018
米国の成人におけるタンパク質尿のスクリーニング:費用対効果分析
L Ebony Boulware1, Bernard G Jaar, Michelle E Tarver-Carr
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA. lboulwa@jhmi.edu
JAMA
|December 18, 2003
まとめ
大人の尿中のタンパク質をスクリーニングすることは,一般の人々にとって費用対効果的ではありません. しかし,高血圧や高齢者をターゲットに,スクリーニングの間隔を頻繁にしないことで,早期慢性腎臓病の検出の費用対効果が向上します.
科学分野:
- ネフロロジーは腎臓科
- 公衆衛生は公衆衛生である.
- 健康経済学 医療経済学
背景:
- 慢性腎臓病 (CKD) は,世界的な健康上の負担を大きく増大させている.
- スクリーニングによるCKDの早期発見は,患者のアウトカムを改善する可能性があるが,過剰診断と医療費の増加のリスクを伴う.
研究 の 目的:
- 成人のタンパク質尿症の早期徴候を検出するための,日常的な,全人口にわたるディップスティックスクリーニングの経済的価値を評価するために.
- この研究では,特に高血圧や糖尿病のない成人と,高血圧を持つ成人のスクリーニングを評価しました.
主な方法:
- マルコフ決定分析モデルを用いて費用対効果の分析を行いました.
- このモデルは,50歳から開始される年間タンパク質尿検診と,検診なし (通常のケア) を比較した.
- 治療戦略には,アニオテンシン変換酵素 (ACE) 阻害剤またはアニオテンシンII受容体阻害剤 (ARB) が含まれていました.
主要な成果:
- 高血圧や糖尿病のない成人をスクリーニングすることは,費用対効果が低かった (QALYあたり282,818ドル).
- 60歳からこれらの個人をスクリーニングすることで,費用対効果が改善されました (QALYあたり53,372ドル).
- 高血圧の成人をスクリーニングすると,費用対効果が高いことが示されました (QALYあたり18,621ドル).
結論:
- ルーティン・プロテイン尿検診は,人口の広範な使用のために費用対効果が高くありません.
- 高リスクグループ,高齢者,高血圧患者などの選択的スクリーニングが推奨されます.
- 頻度の低いスクリーニング (10年ごとに) は,より広範な集団の費用対効果を高める可能性があります.
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