title: The cost-effectiveness of using chronic kidney disease risk scores to screen for early-stage chronic kidney disease.
abstract: BACKGROUND
  Better treatment during early stages of chronic kidney disease (CKD) may slow progression to end-stage renal disease and decrease associated complications and medical costs. Achieving early treatment of CKD is challenging, however, because a large fraction of persons with CKD are unaware of having this disease. Screening for CKD is one important method for increasing awareness. We examined the cost-effectiveness of identifying persons for early-stage CKD screening (i.e., screening for moderate albuminuria) using published CKD risk scores.
  
  
  METHODS
  We used the CKD Health Policy Model, a micro-simulation model, to simulate the cost-effectiveness of using CKD two published risk scores by Bang et al. and Kshirsagar et al. to identify persons in the US for CKD screening with testing for albuminuria. Alternative risk score thresholds were tested (0.20, 0.15, 0.10, 0.05, and 0.02) above which persons were assigned to receive screening at alternative intervals (1-, 2-, and 5-year) for follow-up screening if the first screening was negative. We examined incremental cost-effectiveness ratios (ICERs), incremental lifetime costs divided by incremental lifetime QALYs, relative to the next higher screening threshold to assess cost-effectiveness. Cost-effective scenarios were determined as those with ICERs less than $50,000 per QALY. Among the cost-effective scenarios, the optimal scenario was determined as the one that resulted in the highest lifetime QALYs.
  
  
  RESULTS
  ICERs ranged from $8,823 per QALY to $124,626 per QALY for the Bang et al. risk score and $6,342 per QALY to $405,861 per QALY for the Kshirsagar et al. risk score. The Bang et al. risk score with a threshold of 0.02 and 2-year follow-up screening was found to be optimal because it had an ICER less than $50,000 per QALY and resulted in the highest lifetime QALYs.
  
  
  CONCLUSIONS
  This study indicates that using these CKD risk scores may allow clinicians to cost-effectively identify a broader population for CKD screening with testing for albuminuria and potentially detect people with CKD at earlier stages of the disease than current approaches of screening only persons with diabetes or hypertension.
authors.affiliation: RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA. byarnoff@rti.org.
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Yarnoff
authors.affiliation: RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.affiliation: RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
authors.forename: Siobhan K
authors.initials: SK
authors.lastname: Simpson
authors.affiliation: RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Leib
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Nilka R
authors.initials: NR
authors.lastname: Burrows
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Sundar S
authors.initials: SS
authors.lastname: Shrestha
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Meda E
authors.initials: ME
authors.lastname: Pavkov
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000191:economics / Q000379:methods; D012680:Sensitivity and Specificity
keywords: Chronic kidney disease; Risk scores; Screening