Cost-effectiveness of Primary Screening for CKD: A Systematic Review

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. Study Design: Systematic review. Setting & Population: General, hypertensive, and diabetic populations. No restriction on setting. Selection Criteria for Studies: Studies that evaluated the cost-effectiveness of screening for CKD. Intervention: Screening for CKD by proteinuria or estimated glomerular filtration rate (eGFR). Outcomes: 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. Limitations: 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. (C) 2014 by the National Kidney Foundation, Inc.