title: Methods Used in Economic Evaluations of Chronic Kidney Disease Testing - A Systematic Review.
abstract: BACKGROUND
  The prevalence of chronic kidney disease (CKD) is high in general populations around the world. Targeted testing and screening for CKD are often conducted to help identify individuals that may benefit from treatment to ameliorate or prevent their disease progression.
  
  
  OBJECTIVE
  This systematic review examines the methods used in economic evaluations of testing and screening in CKD, with a particular focus on whether test accuracy has been considered, and how analysis has incorporated issues that may be important to the patient, such as the impact of testing on quality of life and the costs they incur.
  
  
  METHODS
  Articles that described model-based economic evaluations of patient testing interventions focused on CKD were identified through the searching of electronic databases and the hand searching of the bibliographies of the included studies.
  
  
  RESULTS
  The initial electronic searches identified 2,671 papers of which 21 were included in the final review. Eighteen studies focused on proteinuria, three evaluated glomerular filtration rate testing and one included both tests. The full impact of inaccurate test results was frequently not considered in economic evaluations in this setting as a societal perspective was rarely adopted. The impact of false positive tests on patients in terms of the costs incurred in re-attending for repeat testing, and the anxiety associated with a positive test was almost always overlooked. In one study where the impact of a false positive test on patient quality of life was examined in sensitivity analysis, it had a significant impact on the conclusions drawn from the model.
  
  
  CONCLUSIONS
  Future economic evaluations of kidney function testing should examine testing and monitoring pathways from the perspective of patients, to ensure that issues that are important to patients, such as the possibility of inaccurate test results, are properly considered in the analysis.
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Sutton
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Katie
authors.initials: K
authors.lastname: Breheny
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Deeks
authors.affiliation: University of Leicester, Leicester, United Kingdom.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: Claire
authors.initials: C
authors.lastname: Sharpe
authors.affiliation: Birmingham Clinical Trials Unit, School of Cancer Sciences, Robert Aitken Institute, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Ottridge
authors.affiliation: Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, United Kingdom.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Stevens
authors.affiliation: Queen Elizabeth Hospital Birmingham, Division of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
authors.affiliation: Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors.forename: Philp A
authors.initials: PA
authors.lastname: Kalra
authors.affiliation: Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury Kent, United Kingdom.
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Lamb
mesh_terms: D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D007677:Kidney Function Tests / Q000191:economics* / Q000379:methods* / Q000592:standards; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis*; D015203:Reproducibility of Results