title: Cost-effectiveness of chronic kidney disease mass screening test in Japan.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a significant public health problem. Strategy for its early detection is still controversial. This study aims to assess the cost-effectiveness of population strategy, i.e. mass screening, and Japan's health checkup reform.
  
  
  METHODS
  Cost-effectiveness analysis was carried out to compare test modalities in the context of reforming Japan's mandatory annual health checkup for adults. A decision tree and Markov model with societal perspective were constructed to compare dipstick test to check proteinuria only, serum creatinine (Cr) assay only, or both.
  
  
  RESULTS
  Incremental cost-effectiveness ratios (ICERs) of mass screening compared with do-nothing were calculated as ¥1,139,399/QALY (US $12,660/QALY) for dipstick test only, ¥8,122,492/QALY (US $90,250/QALY) for serum Cr assay only and ¥8,235,431/QALY (US $91,505/QALY) for both. ICERs associated with the reform were calculated as ¥9,325,663/QALY (US $103,618/QALY) for mandating serum Cr assay in addition to the currently used mandatory dipstick test, and ¥9,001,414/QALY (US $100,016/QALY) for mandating serum Cr assay and applying dipstick test at discretion.
  
  
  CONCLUSIONS
  Taking a threshold to judge cost-effectiveness according to World Health Organization's recommendation, i.e. three times gross domestic product per capita of ¥11.5 million/QALY (US $128 thousand/QALY), a policy that mandates serum Cr assay is cost-effective. The choice of continuing the current policy which mandates dipstick test only is also cost-effective. Our results suggest that a population strategy for CKD detection such as mass screening using dipstick test and/or serum Cr assay can be justified as an efficient use of health care resources in a population with high prevalence of the disease such as in Japan and Asian countries.
authors.affiliation: Department of Health Care Policy and Management, Graduate School of Comprehensive Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8577, Japan. mkondo@md.tsukuba.ac.jp
authors.forename: Masahide
authors.initials: M
authors.lastname: Kondo
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yamagata
authors.forename: Shu-ling
authors.initials: SL
authors.lastname: Hoshi
authors.forename: Chie
authors.initials: C
authors.lastname: Saito
authors.forename: Koichi
authors.initials: K
authors.lastname: Asahi
authors.forename: Toshiki
authors.initials: T
authors.lastname: Moriyama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuruya
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yoshida
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003404:Creatinine / Q000097:blood*; D003663:Decision Trees; D006801:Humans; D007564:Japan; D008403:Mass Screening / Q000191:economics*; D011507:Proteinuria; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis* / Q000191:economics
chemical_list: D003404:Creatinine