Population Screening for CKD: Is It Cost-Effective Now?

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In the era of sodium-glucose cotransporter-2 (SGLT2) inhibitor therapy, population-wide screening for albuminuria to identify chronic kidney disease (CKD) would be a cost-effective practice, suggests a study in the Annals of Internal Medicine.

The researchers designed a decision analytic Markov cohort model of CKD progression among U.S. adults aged 35 years or older. Cost-effectiveness analysis focused on the impact of screening for albuminuria from a health care sector perspective, with and without adding SGLT2 inhibitors to the standard of care for CKD. Data for the analysis came from the National Health and Nutrition Examination Survey, Centers for Medicare & Medicaid Services databases, and published studies including the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial.

One-time screening with the addition of SGLT2 inhibitors at aged 55 years increased costs from $249,000 to $259,000 and increased quality-adjusted life-years (QALYs) from 12.61 to 12.72, for an incremental cost-effectiveness ratio of $86,300 per QALY gained. This screening strategy reduced the incidence of kidney failure requiring dialysis or transplantation by 0.29 percentage points while increasing life expectancy from 17.29 to 17.45 years.

Other strategies were also cost-effective. One-time screening between aged 35 and 75 years avoided dialysis or transplantation in 380,000 people. For a strategy of screening every 10 years up to aged 75 years, cost per QALY gained was less than $100,000. In sensitivity analyses, costs per QALY were affected by the estimated effectiveness and costs of SGLT2 inhibitors.

Trials have demonstrated the efficacy of SGLT2 inhibitor therapy in patients with CKD, with and without diabetes. This new treatment appears capable of altering the natural history of CKD, suggesting that it should be included in cost-effectiveness analyses of CKD screening.

“Screening adults for albuminuria to identify CKD could be cost-effective in the United States,” the researchers conclude. In contrast to studies performed before the availability of SGLT2 inhibitor therapy, “[B]oth one-time and periodic screening for CKD represent very good value in every age group when SGLT2 inhibitors are included in treatment [Cusick MM, et al. Population-wide screening for chronic kidney disease: A cost-effectiveness analysis. Ann Intern Med 2023; 176:788–797. doi: 10.7326/M22-3228].