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Research

Population based screening for chronic kidney disease: cost effectiveness study

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5869 (Published 08 November 2010) Cite this as: BMJ 2010;341:c5869
  1. Braden Manns, associate professor of medicine1234,
  2. Brenda Hemmelgarn, associate professor of medicine 1234,
  3. Marcello Tonelli, associate professor of medicine45,
  4. Flora Au, research analyst24,
  5. T Carter Chiasson, BHSc student4,
  6. James Dong, research analyst45,
  7. Scott Klarenbach, associate professor of medicine45
  8. on behalf of the Alberta Kidney Disease Network
  1. 1Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2Community Health Sciences, University of Calgary, Calgary
  3. 3Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary
  4. 4Alberta Kidney Disease Network, Calgary
  5. 5Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta
  1. Correspondence to: B Manns, Foothills Medical Centre, 1403 29th St. NW Calgary, Alberta Canada T2N 2T9 Braden.Manns{at}albertahealthservices.ca
  • Accepted 2 September 2010

Abstract

Objective To determine the cost effectiveness of one-off population based screening for chronic kidney disease based on estimated glomerular filtration rate.

Design Cost utility analysis of screening with estimated glomerular filtration rate alone compared with no screening (with allowance for incidental finding of cases of chronic kidney disease). Analyses were stratified by age, diabetes, and the presence or absence of proteinuria. Scenario and sensitivity analyses, including probabilistic sensitivity analysis, were performed. Costs were estimated in all adults and in subgroups defined by age, diabetes, and hypertension.

Setting Publicly funded Canadian healthcare system.

Participants Large population based laboratory cohort used to estimate mortality rates and incidence of end stage renal disease for patients with chronic kidney disease over a five year follow-up period. Patients had not previously undergone assessment of glomerular filtration rate.

Main outcome measures Lifetime costs, end stage renal disease, quality adjusted life years (QALYs) gained, and incremental cost per QALY gained.

Results Compared with no screening, population based screening for chronic kidney disease was associated with an incremental cost of $C463 (Canadian dollars in 2009; equivalent to about £275, €308, US $382) and a gain of 0.0044 QALYs per patient overall, representing a cost per QALY gained of $C104 900. In a cohort of 100 000 people, screening for chronic kidney disease would be expected to reduce the number of people who develop end stage renal disease over their lifetime from 675 to 657. In subgroups of people with and without diabetes, the cost per QALY gained was $C22 600 and $C572 000, respectively. In a cohort of 100 000 people with diabetes, screening would be expected to reduce the number of people who develop end stage renal disease over their lifetime from 1796 to 1741. In people without diabetes with and without hypertension, the cost per QALY gained was $C334 000 and $C1 411 100, respectively.

Conclusions Population based screening for chronic kidney disease with assessment of estimated glomerular filtration rate is not cost effective overall or in subgroups of people with hypertension or older people. Targeted screening of people with diabetes is associated with a cost per QALY that is similar to that accepted in other interventions funded by public healthcare systems.

Footnotes

  • Contributors: BM, SK, MT, and BH made substantial contributions to study conception and design, drafting, and critical revision. BM, SK, BH, FA, JD, and TCC were involved with data analysis and interpretation of data. BM is guarantor.

  • Funding: This study was supported by an operating grant from Alberta Heritage Foundation for Medical Research (now Alberta Innovates-Health Solutions). The infrastructure required for this research was also supported by the Alberta Heritage Foundation for Medical Research Interdisciplinary Team Grants Program (which supports the Interdisciplinary Chronic Disease Collaboration). The funding organisations played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. BM, MT, and BH are supported by New Investigator Awards from the Canadian Institutes of Health Research and MT, SK, BM, and BH are supported by salary awards from Alberta Innovates-Health Solutions.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: this project was supported by an operating grant from Alberta Heritage Foundation for Medical Research (now Alberta Innovates-Health Solutions) for the submitted work; no financial relationships with any companies that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Calgary Health Region ethics board.

  • Data sharing: No additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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