title: Cost of screening strategies for kidney disease before intravenous contrast administration.
abstract: OBJECTIVE
  To assess whether selective use of estimated glomerular filtration rate (eGFR) in patients with risk factors for kidney disease is more cost-effective than measuring eGFR in all patients undergoing contrast-enhanced computed tomography (CECT).
  
  
  METHODS
  Risk factors and costs were assessed in consecutive patients. eGFR was evaluated in all patients, considering a tenability of 12 months. For the three-month tenability and the pre-selection strategy based on risk factors for kidney disease, we extrapolated data by assuming equal distribution of patient characteristics.
  
  
  RESULTS
  We included 1001 patients, mean age 59.9 ± 13.6 years. Strategy with eGFR in all patients: eGFR measurements specifically performed for CECT in 645/1001 (in 356 patients the eGFR was already known). The total cost including costs of an extra visit to the hospital (49 patients) and absence from work (11 patients) were € 6037.20. Considering a tenability of 3 months, eGFR had to be measured in 786 patients, 60 would have paid an extra visit and 14 would have been absent from work: total cost € 7443.54. Pre-selection strategy: 807 patients had risk factors, necessitating eGFR measurement and an extra visit would be paid by 61. Fourteen patients would have been absent from work: total cost € 7585.16. Of the patients with an eGFR <60 ml/min/1.73 m(2), 94.8% were identified including all with an eGFR <45 ml/min/1.73 m(2).
  
  
  CONCLUSIONS
  Determining eGFR based on risk factors for kidney disease is not more cost-effective than eGFR testing in all patients if the eGFR is tenable for 12 months or for 3 months.
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: S I
authors.initials: SI
authors.lastname: Moos
authors.forename: R S
authors.initials: RS
authors.lastname: de Weijert
authors.forename: G
authors.initials: G
authors.lastname: Nagan
authors.forename: J
authors.initials: J
authors.lastname: Stoker
authors.forename: S
authors.initials: S
authors.lastname: Bipat
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology*; D061605:Administration, Intravenous; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D004526:Efficiency; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014186:Transportation / Q000191:economics
chemical_list: D003287:Contrast Media