title: Cost-effectiveness of screening for microalbuminuria among African Americans.
abstract: Compared with other racial groups, African Americans have a similar prevalence of CKD but are much more likely to progress to ESRD, suggesting that the cost-effectiveness of screening strategies requires dedicated study in this population. Here, we calibrated the CKD Health Policy Model so that it accurately forecasts the higher rates for ESRD observed for African Americans. We then used the calibrated model to estimate the cost-effectiveness of screening for microalbuminuria followed by treatment with angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers. Incorporating racial differences in risk factors did not fully explain the much higher lifetime incidence of ESRD among African Americans. Thus, to calibrate the model, we applied a 20% increase in the rate of GFR decline at stage 3 and a 60% increase in the rate of GFR decline at stage 4, which resulted in a model that closely reflects lifetime ESRD incidence among African Americans. Compared with usual care, screening African Americans for microalbuminuria at 10-, 5-, 2-, and 1-year intervals had incremental cost-effectiveness ratios of $9000, $11,000, $19,000, and $35,000 per quality-adjusted life year, respectively. Incremental cost-effectiveness ratios for the same screening intervals were higher for non-African Americans: $17,000, $23,000, $44,000, and $81,000 per quality-adjusted life year, respectively. In summary, these models suggest that screening African Americans for microalbuminuria at either 5- or 10-year intervals is highly cost-effective.
authors.affiliation: RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA. tjh@rti.org
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.forename: John S
authors.initials: JS
authors.lastname: Wittenborn
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zhuo
authors.forename: Meda E
authors.initials: ME
authors.lastname: Pavkov
authors.forename: Nilka R
authors.initials: NR
authors.lastname: Burrows
authors.forename: Paul
authors.initials: P
authors.lastname: Eggers
authors.forename: Regina
authors.initials: R
authors.lastname: Jordan
authors.forename: Sharon
authors.initials: S
authors.lastname: Saydah
authors.forename: Desmond E
authors.initials: DE
authors.lastname: Williams
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000419:Albuminuria / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000208:ethnology*; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D008962:Models, Theoretical