title: Cost-effectiveness of primary screening for CKD: a systematic review.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a major health problem with an increasing incidence worldwide. Data on the cost-effectiveness of CKD screening in the general population have been conflicting.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  General, hypertensive, and diabetic populations. No restriction on setting.
  
  
  METHODS
  Studies that evaluated the cost-effectiveness of screening for CKD.
  
  
  METHODS
  Screening for CKD by proteinuria or estimated glomerular filtration rate (eGFR).
  
  
  RESULTS
  Incremental cost-effectiveness ratio of screening by proteinuria or eGFR compared with either no screening or usual care.
  
  
  RESULTS
  9 studies met criteria for inclusion. 8 studies evaluated the cost-effectiveness of proteinuria screening and 2 evaluated screening with eGFR. For proteinuria screening, incremental cost-effectiveness ratios ranged from $14,063-$160,018/quality-adjusted life-year (QALY) in the general population, $5,298-$54,943/QALY in the diabetic population, and $23,028-$73,939/QALY in the hypertensive population. For eGFR screening, one study reported a cost of $23,680/QALY in the diabetic population and the range across the 2 studies was $100,253-$109,912/QALY in the general population. The incidence of CKD, rate of progression, and effectiveness of drug therapy were major drivers of cost-effectiveness.
  
  
  CONCLUSIONS
  Few studies evaluated screening by eGFR. Performance of a quantitative meta-analysis on influential assumptions was not conducted because of few available studies and heterogeneity in model designs.
  
  
  CONCLUSIONS
  Screening for CKD is suggested to be cost-effective in patients with diabetes and hypertension. CKD screening may be cost-effective in populations with higher incidences of CKD, rapid rates of progression, and more effective drug therapy.
authors: Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada. Electronic address: paulkomenda@yahoo.com.
authors: Paul
authors: P
authors: Komenda
authors: Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
authors: Thomas W
authors: TW
authors: Ferguson
authors: Department of Library Services, University of Manitoba, Winnipeg, Canada.
authors: Kerry
authors: K
authors: Macdonald
authors: Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
authors: Claudio
authors: C
authors: Rigatto
authors: Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
authors: Chris
authors: C
authors: Koolage
authors: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
authors: Manish M
authors: MM
authors: Sood
authors: Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
authors: Navdeep
authors: N
authors: Tangri
mesh_terms: D003362:Cost-Benefit Analysis; D014943:Global Health; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology
keywords: Cost-effectiveness analysis; chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR); incremental cost-effectiveness ratio (ICER); proteinuria; public health screening; risk stratification