Population based screening for chronic kidney disease: cost effectiveness study.
OBJECTIVE
To determine the cost effectiveness of one-off population based screening for chronic kidney disease based on estimated glomerular filtration rate.


METHODS
Cost utility analysis of screening with estimated glomerular filtration rate alone compared with no screening (with allowance for incidental finding of cases of chronic kidney disease). Analyses were stratified by age, diabetes, and the presence or absence of proteinuria. Scenario and sensitivity analyses, including probabilistic sensitivity analysis, were performed. Costs were estimated in all adults and in subgroups defined by age, diabetes, and hypertension.


METHODS
Publicly funded Canadian healthcare system.


METHODS
Large population based laboratory cohort used to estimate mortality rates and incidence of end stage renal disease for patients with chronic kidney disease over a five year follow-up period. Patients had not previously undergone assessment of glomerular filtration rate.


METHODS
Lifetime costs, end stage renal disease, quality adjusted life years (QALYs) gained, and incremental cost per QALY gained.


RESULTS
Compared with no screening, population based screening for chronic kidney disease was associated with an incremental cost of $C463 (Canadian dollars in 2009; equivalent to about £275, €308, US $382) and a gain of 0.0044 QALYs per patient overall, representing a cost per QALY gained of $C104 900. In a cohort of 100 000 people, screening for chronic kidney disease would be expected to reduce the number of people who develop end stage renal disease over their lifetime from 675 to 657. In subgroups of people with and without diabetes, the cost per QALY gained was $C22 600 and $C572 000, respectively. In a cohort of 100 000 people with diabetes, screening would be expected to reduce the number of people who develop end stage renal disease over their lifetime from 1796 to 1741. In people without diabetes with and without hypertension, the cost per QALY gained was $C334 000 and $C1 411 100, respectively.


CONCLUSIONS
Population based screening for chronic kidney disease with assessment of estimated glomerular filtration rate is not cost effective overall or in subgroups of people with hypertension or older people. Targeted screening of people with diabetes is associated with a cost per QALY that is similar to that accepted in other interventions funded by public healthcare systems.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Braden.Manns@albertahealthservices.ca
Braden
B
Manns
Brenda
B
Hemmelgarn
Marcello
M
Tonelli
Flora
F
Au
T Carter
TC
Chiasson
James
J
Dong
Scott
S
Klarenbach
D000368:Aged; D000416:Alberta / Q000453:epidemiology; D057911:Angiotensin Receptor Antagonists / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000191:economics / Q000401:mortality; D008297:Male; D008390:Markov Chains; D010349:Patient Compliance; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics / Q000401:mortality; D012307:Risk Factors
D057911:Angiotensin Receptor Antagonists