OBJECTIVES: Development of chronic kidney disease (CKD) is an increasing health problem. Interventions for management of CKD are most effective in early stages of disease, which underlines the importance of prevention and early detection. Hence, a sensitive and low-cost screening strategy for the general population could offer substantial health(economic) benefits. This study assessed the costs and related sensitivity of various screening strategies for identifying individuals at high risk of CKD.

METHODS: The cost- and sensitivity analyses were performed on screening strategies involving a newly developed “Alssema-algorithm” (i.e. an 8-questions questionnaire on age, gender, family history of disease, lifestyle and medical history) combined with existing risk-factor based screening strategies (e.g. albumin-to-creatinine ratio (ACR), blood pressure, lipid profile, glycated hemoglobin), in the end followed by a confirmation test. Costs for screening and confirmation tests were estimated based on Dutch tariffs. Individuals identified with KDIGO-risk categories “Orange” and “Red” were considered high risk categories. Sensitivity of the strategies were determined as the number of individuals confirmed to be at high risk per total number of individuals considered to be at high risk following the screening only.

RESULTS: The strategy of screening via ACR and “Alssema-algorithm” in parallel, resulted in the highest sensitivity with 98% and a cost per identified high-risk case at €7.039,51. Performing ACR-only resulted in a sensitivity of 80.5% and a cost per identified high-risk case at €3.118,69. The difference in costs is explained by the high number of false positives (98%) resulting from the ACR and “Alssema-algorithm” parallel testing.

CONCLUSIONS: This study provides evidence that screening the general population via ACR (combined with the “Alssema-algorithm”) provides an effective way of identifying individuals at risk. Our analysis can serve as the basis for a cost-effectiveness analysis, also including long-term effects and costs of interventions after active screening, such as drug treatments.