A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
Thomas J HoergerCenters for Disease Control and Prevention CKD Initiative

Abstract

Microalbuminuria screening may detect chronic kidney disease in its early stages, allowing for treatment that delays or prevents disease progression. The cost-effectiveness of microalbuminuria screening has not been determined. A cost-effectiveness model simulating disease progression and costs. US patients. MODEL, PERSPECTIVE, AND TIMEFRAME: The microsimulation model follows up disease progression and costs in a cohort of simulated patients from age 50 to 90 years or death. Costs are evaluated from the health care system perspective. Microalbuminuria screening at 1-, 2-, 5-, or 10-year intervals followed by treatment with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We considered universal screening, as well as screening targeted at persons with diabetes, persons with hypertension but no diabetes, and persons with neither diabetes nor hypertension. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. For the full model population, universal screening increases costs and increases QALYs. Universal annual screening starting at age 50 years has a cost-effectiveness ratio of $73,000/QALY relative to no screening and $145,000/QALY relative to usual care. Cost-effect...Continue Reading

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