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. 2025 May;29(5):583-595.
doi: 10.1007/s10157-024-02600-9. Epub 2024 Dec 16.

The health-economic impact of urine albumin-to-creatinine ratio testing for chronic kidney disease in Japanese non-diabetic patients

Tsuneo Konta  1 , Koichi Asahi  2 , Kouichi Tamura  3 , Fumitaka Tanaka  2 , Akira Fukui  4 , Yusuke Nakamura  5 , Junichi Hirose  5 , Kenichi Ohara  5 , Yoko Shijoh  6 , Matthew Carter  7 , Kimberley Meredith  7 , James Harris  7 , Örjan Åkerborg  7 , Naoki Kashihara  8 , Takashi Yokoo  4
Affiliations

The health-economic impact of urine albumin-to-creatinine ratio testing for chronic kidney disease in Japanese non-diabetic patients

Tsuneo Konta et al. Clin Exp Nephrol. 2025 May.

Abstract

Background: The objective of this analysis was to estimate the clinical and economic impact of undertaking urine albumin-to-creatinine ratio (UACR) testing alongside regular estimated glomerular filtration rate testing for chronic kidney disease in non-diabetic Japanese patients versus no testing and versus urine protein-creatinine ratio (UPCR) testing.

Methods: An economic model, taking a Japanese healthcare perspective, estimated the health-economic impact of UACR testing over a lifetime time horizon. Outcomes reported were additional costs, clinical benefits measured, such as prevented dialyses and cardiovascular events, quality-adjusted life years gained, and incremental cost-effectiveness ratios. Health states were derived from risk levels reported in the Kidney Disease: Improving Global Outcomes heatmap. Results were derived assuming that after testing, treatment was available in the form of current standard-of-care or emerging chronic kidney disease therapies.

Results: Repeated UACR testing was found to be cost-effective compared to both no urine testing and UPCR testing, with incremental cost-effectiveness ratios of ¥1,953,958 and ¥1,966,433, respectively.

Conclusion: Overall, this model demonstrates the health-economic value of undertaking UACR testing within the non-diabetic Japanese population.

Keywords: Albuminuria; Chronic; Cost-effectiveness analysis; Japan; Renal insufficiency.

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Conflict of interest statement

Declarations. Conflict of interest: T.K. reports personal fees from Bayer Yakuhin, Daiichi-Sankyo, MSD, Japan Boehringer Ingelheim, Sanwa Kagaku, Dainippon-Sumitomo, Kowa, Kyowa Kirin, Astellas Pharm, AstraZeneca, and Kissei, grants and personal fees from Chugai, Mochida, Tanabe-Mitsubishi Pharm and Novartis, outside the submitted work. K.A. reports payment or honoraria from AstraZeneca, Kyowa-Kirin, Mochida, Bayer, Astellas, Otsuka and Tanabe Mitsubishi, outside the submitted work. K.T. reports grants from AstraZeneca, Ono, Bayer, Kyowa-Kirin, Otsuka, Takeda, and Daiichi-Sankyo, outside the submitted work, payment or honoraria from Novartis, AstraZeneca, Ono, Daiichi-Sankyo, Takeda, Otsuka, Bayer, and Kyowa-Kirin, outside the submitted work. F.T. declares no relevant or material financial interests that relate to the research described in this paper. A.F. declares no relevant or material financial interests that relate to the research described in this paper. Y.N., J.H., K.O., and Y.S. are employees of Bayer Yakuhin Ltd. M.C., K.M., J.Harris, and Ö.Å. are employees of Wickenstones and were contracted as consultants by Bayer for the submitted work. N.K. declares payment or honoraria from Bayer, Ono, Novartis, Boehringer Ingelheim Japan, Astellas, and AstraZeneca, consulting fees and payment or honoraria from Kyowa Kirin and Novo Nordisk, leadership or fiduciary role in Japanese Society of Nephrology and Japan Kidney Association, outside the submitted work. T.Y. declares grants from Zenjinkai, Fuji Yakuhin Co. Ltd., Otsuka Pharmaceutical, Nippon Boehringer Ingelheim Co. Ltd., Kyowa Kirin Co. Ltd., Chugai Pharmaceutical Co. Ltd., Baxter Limited, Teijin Pharma, Daiichi Sankyo Company Limited, Sumitomo Pharma Co. Ltd. (Sumitomo Dainippon Pharma CO. LTD.), Ping An-Shionogi Co. Ltd., Mitsubishi Tanabe Pharma Corporation, Torii Medical Plaza, Eli Lilly Japan K.K., Takeda Pharmaceuticals, Kissei Pharmaceutical Co. Ltd., and Mochida Pharmaceutical Plant Co. Ltd, payment or honoraria from Takeda Pharmaceuticals, Chugai Pharmaceutical Co. Ltd., Sumitomo Pharma Co. Ltd. (Sumitomo Dainippon Pharma Co. Ltd.), Kyowa Kirin Co. Ltd., AstraZeneca K.K., Kissei Pharmaceutical Co. Ltd., Astellas Pharma Inc., Nippon Boehringer Ingelheim Co. Ltd., Bayer Yakuhin Ltd., Torii Medical Plaza, Novo Nordisk Pharma Ltd., Sanofi K.K., and Fuso Pharmaceuticals Industries Ltd. Ethics approval: Not applicable. Informed consent: Not applicable.

Figures

Fig. 1
Fig. 1
Decision tree exploring the diagnosis and subsequent treatment/management resulting from different tests for the identification of kidney damage. Test options 1 and 2 can be either UACR, UPCR, or no-testing, depending on the comparison of interest. Where UPCR testing is selected, the test results instead refer to the corresponding proteinuria categories: macroalbuminuria corresponds to severely increased proteinuria, microalbuminuria corresponds to mildly/moderately increased proteinuria, and normoalbuminuria corresponds to normal to mildly increased proteinuria. Abbreviations: CKD, chronic kidney disease; UACR, urine albumin-to-creatinine ratio; UPCR, urine protein-creatinine ratio
Fig. 2
Fig. 2
Health state diagram for patient flow within Markov model. Abbreviations: CKD, chronic kidney disease
Fig. 3
Fig. 3
Cost-effectiveness of UACR versus UPCR by treatment paradigm. Abbreviations: ACEi/ARBs, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers; ICER, incremental cost-effectiveness ratio; SGLT2is, sodium–glucose cotransporter-2 inhibitors; UACR, urine albumin-to-creatinine ratio; UPCR, urine protein-creatinine ratio; WTP, willingness-to-pay
See this image and copyright information in PMC

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