OBJECTIVES:

Screening for albuminuria allows for early detection and treatment of individuals with chronic kidney disease (CKD), which is a risk factor for experiencing cardiovascular events (CVEs). Currently, the evidence on the cost effectiveness of screening for albuminuria in the general population is not conclusive. This study aimed to evaluate the cost effectiveness of a home-based general population screening (45-80 years old) for increased albuminuria in the Netherlands.

METHODS:

A microsimulation model was developed to compare screening using a urine collection device (UCD) with usual care (no screening). The screening process, CKD progression and events (dialysis and renal transplantation), and CVEs were included in the model. Albuminuria detection during screening led to treatment initiation.

Individual-level data and model inputs for screening participation were obtained from the Towards HOMe-based Albuminuria Screening (THOMAS) study. The risk of experiencing CVEs was calculated using the SCORE2 risk prediction model and the individual-level data from THOMAS. Relative treatment effectiveness, utilities, resource use, and costs inputs were obtained from the literature.

Model outcomes were the number of CKD-related events, and total costs and quality-adjusted life-years (QALYs) per strategy. The incremental cost-effectiveness ratios (ICERs) of UCD versus usual care was calculated. A scenario analysis investigated the impact of reducing treatment adherence by 5% yearly.

RESULTS:

The screening strategy reduced the number of dialyses (-0.04 %), renal transplantations (-0.01%) , and CVEs (non-fatal myocardial infarction: -0.56%, non-fatal stroke: -0.66% and fatal CVE: -0.47%) compared with usual care. The UCD strategy led to 0.25 incremental QALYs and €1,628 incremental costs versus usual care (ICER: €6,480). Decreasing treatment adherence decreased the incremental QALYs (0.19 QALYs) and increased the incremental costs (€1,768) of UCD versus usual care (ICER: €9,327).

CONCLUSIONS:

The UCD strategy seems cost effective compared with usual care for screening for albuminuria in the Dutch general population.