Inside CKD: Cost-Effectiveness of Multinational Screening for CKD

Abstract

Introduction

Early detection of chronic kidney disease (CKD) could slow its progression; however, most patients in earlier stages remain undiagnosed. Our study objective was to assess the cost-effectiveness of multinational CKD screening strategies from the payer perspective across general and higher-risk populations.

Methods

Using the published Inside CKD microsimulation, we projected virtual closed populations to assess CKD screening strategies in 31 countries or regions over a lifetime horizon. We considered people aged ≥ 65 or ≥ 45 years in the general population and in high-risk subgroups (type 2 diabetes [T2D], hypertension, or cardiovascular disease [CVD]). Simulated populations could receive 2 serum creatinine (SCr) tests assessing estimated glomerular filtration rate (eGFR), “2 eGFR only”, or an additional urinary albumin-to-creatinine ratio test (UACR), “2 eGFR and 1 UACR”, versus current practice. Eligible patients received renin-angiotensin system inhibitors (RASi).

Results

Screening the general population aged ≥ 45 years for CKD was cost-effective versus current practice in all countries or regions using the “2 eGFR and 1 UACR” strategy, and cost-effective in all but 1 country using the 2 eGFR only strategy. The 2 eGFR and 1 UACR strategy showed consistently higher cost-effectiveness. Screening general populations aged ≥ 45 years increased projected CKD diagnosis rates per 100,000 persons eligible for screening from 459 by current practice to 7475 patients using 2 eGFR only, or 14,392 using 2 eGFR and 1 UACR. Similar trends in cost-effectiveness and diagnosis rates were observed in persons aged ≥ 65 years.

Conclusion

CKD screening may be cost-effective in general populations worldwide, including in populations aged ≥ 45 years. Our analysis corroborates global guideline recommendations for simultaneous eGFR and UACR testing if considered in the context of local factors.