Cost-effectiveness of primary screening for CKD: a systematic review

Abstract

Background: Chronic kidney disease (CKD) is a major health problem with an increasing incidence worldwide. Data on the cost-effectiveness of CKD screening in the general population have been conflicting.

Study design: Systematic review.

Setting & population: General, hypertensive, and diabetic populations. No restriction on setting.

Selection criteria for studies: Studies that evaluated the cost-effectiveness of screening for CKD.

Intervention: Screening for CKD by proteinuria or estimated glomerular filtration rate (eGFR).

Outcomes: Incremental cost-effectiveness ratio of screening by proteinuria or eGFR compared with either no screening or usual care.

Results: 9 studies met criteria for inclusion. 8 studies evaluated the cost-effectiveness of proteinuria screening and 2 evaluated screening with eGFR. For proteinuria screening, incremental cost-effectiveness ratios ranged from $14,063-$160,018/quality-adjusted life-year (QALY) in the general population, $5,298-$54,943/QALY in the diabetic population, and $23,028-$73,939/QALY in the hypertensive population. For eGFR screening, one study reported a cost of $23,680/QALY in the diabetic population and the range across the 2 studies was $100,253-$109,912/QALY in the general population. The incidence of CKD, rate of progression, and effectiveness of drug therapy were major drivers of cost-effectiveness.

Limitations: Few studies evaluated screening by eGFR. Performance of a quantitative meta-analysis on influential assumptions was not conducted because of few available studies and heterogeneity in model designs.

Conclusions: Screening for CKD is suggested to be cost-effective in patients with diabetes and hypertension. CKD screening may be cost-effective in populations with higher incidences of CKD, rapid rates of progression, and more effective drug therapy.

Keywords: Cost-effectiveness analysis; chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR); incremental cost-effectiveness ratio (ICER); proteinuria; public health screening; risk stratification.