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

Abstract

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have the potential to alter the natural history of chronic kidney disease (CKD), and they should be included in cost-effectiveness analyses of screening for CKD.

Objective: To determine the cost-effectiveness of adding population-wide screening for CKD.

Design: Markov cohort model.

Data sources: NHANES (National Health and Nutrition Examination Survey), U.S. Centers for Medicare & Medicaid Services data, cohort studies, and randomized clinical trials, including the DAPA-CKD (Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease) trial.

Target population: Adults.

Time horizon: Lifetime.

Perspective: Health care sector.

Intervention: Screening for albuminuria with and without adding SGLT2 inhibitors to the current standard of care for CKD.

Outcome measures: Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), all discounted at 3% annually.

Results of base-case analysis: One-time CKD screening at age 55 years had an ICER of $86 300 per QALY gained by increasing costs from $249 800 to $259 000 and increasing QALYs from 12.61 to 12.72; this was accompanied by a decrease in the incidence of kidney failure requiring dialysis or kidney transplant of 0.29 percentage points and an increase in life expectancy from 17.29 to 17.45 years. Other options were also cost-effective. During ages 35 to 75 years, screening once prevented dialysis or transplant in 398 000 people and screening every 10 years until age 75 years cost less than $100 000 per QALY gained.

Results of sensitivity analysis: When SGLT2 inhibitors were 30% less effective, screening every 10 years during ages 35 to 75 years cost between $145 400 and $182 600 per QALY gained, and price reductions would be required for screening to be cost-effective.

Limitation: The efficacy of SGLT2 inhibitors was derived from a single randomized controlled trial.

Conclusion: Screening adults for albuminuria to identify CKD could be cost-effective in the United States.

Primary funding source: Agency for Healthcare Research and Quality, Veterans Affairs Office of Academic Affiliations, and National Institute of Diabetes and Digestive and Kidney Diseases.

Figure 1.

Changes in incidence of KF on KRT (a) and average life expectancy (b) from population-wide CKD screening in comparison to status quo detection and treatment with ACE inhibitors/ARB therapy ACE inhibitor: angiotensin-converting enzyme inhibitors ARB therapy: angiotensin receptor blocker therapy SGTL2 inhibitor: Sodium glucose co-transporter 2 inhibitor KF on KRT: kidney failure on kidney replacement therapy Status quo*: case detection and treatment with ACE inhibitor/ARB therapy

Figure 2.

Cost-effectiveness plane (55-year-olds) (65)* *Red numbers indicate incremental cost-effectiveness ratios represented in costs ($) per QALY gained ACE inhibitor: angiotensin-converting enzyme inhibitors ARB therapy: angiotensin receptor blocker therapy SGTL2 inhibitor: Sodium glucose co-transporter 2 inhibitor QALYs: quality-adjusted life years