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


METHODS
A cost-effectiveness model simulating disease progression and costs.


METHODS
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.


METHODS
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.


RESULTS
Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.


RESULTS
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-effectiveness ratios improved with longer screening intervals. Relative to no screening, targeted annual screening has cost-effectiveness ratios of $21,000/QALY, $55,000/QALY, and $155,000/QALY for persons with diabetes, those with hypertension, and those with neither current diabetes nor current hypertension, respectively.


CONCLUSIONS
Results necessarily are based on a microsimulation model because of the long time horizon appropriate for chronic kidney disease. The model includes only health care costs.


CONCLUSIONS
Microalbuminuria screening is cost-effective for patients with diabetes or hypertension, but is not cost-effective for patients with neither diabetes nor hypertension unless screening is conducted at longer intervals or as part of existing physician visits.
Hoerger
Thomas J
TJ
RTI International, Research Triangle Park, NC 27709, USA. tjh@rti.org
Wittenborn
John S
JS
Segel
Joel E
JE
Burrows
Nilka R
NR
Imai
Kumiko
K
Eggers
Paul
P
Pavkov
Meda E
ME
Jordan
Regina
R
Hailpern
Susan M
SM
Schoolwerth
Anton C
AC
Williams
Desmond E
DE
D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis* / Q000191:economics* / Q000209:etiology; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged