Chronic kidney disease: cost-effectiveness of screening

Chronic kidney disease (CKD) is an important cause of morbidity and mortality. In the US, around 15% of the adult population is affected by it, although in 90% of these people it is undiagnosed, with the condition usually being asymptomatic in its early stages. As well as the importance of slowing the progression of CKD to prevent kidney failure, there is a huge imperative to reduce the economic burden of care.

Despite the availability of simple diagnostic tests for CKD, there is no consensus on the best approach to the timely screening for previously unrecognised disease. However, the demonstration in recent years of the modifying effects of SGLT2 inhibitors on kidney disease, in people with or without diabetes, has prompted new interest in re-evaluating the balance of benefits and harms associated with screening for CKD.

In the present study, researchers analysed the cost-effectiveness of population-wide CKD screening in US adults, with and without the use of an SGLT2 inhibitor, using UACR as the screening intervention and starting at the age of 35 years. A model of CKD progression among US adults was developed, and calibrated with real-world data. The model simulated CKD progression over an individual’s lifetime at 3-month intervals. 

Compared to the status quo, analysis found that screening and early diagnosis in the US population would increase life expectancy in those aged 35–75 years by at least 0.07 years. It would also increase QALYs and decrease incidence of kidney failure requiring kidney replacement therapy. By identifying previously undiagnosed CKD, treatment costs would increase. When SGLT2 inhibitors are included in treatment, however, both one-time and periodic screening are cost-effective in every age group.

For those aged 35–45 years, good value would be provided by screening every 10 years, whilst the higher prevalence of CKD in those aged 55–65 years would make screening every 5 years reasonable. 

In scenarios in which SGLT2 inhibitors were 30% less effective than they have been found to be in clinical trials, the price of the medication would need to decrease for screening every 10 years to be cost-effective in those aged 35–75 years. This reduction may become likely as patents near their ends.

The authors conclude that using UACR screening for CKD in the general US population aged ≥35 years, followed by ACE inhibitor or ARB therapy and SGLT2 inhibitors, would be cost-effective.

The full study can be read here.