OBJECTIVES: Chronic kidney disease (CKD) affects approximately 12% of the population in Belgium, with diagnosis mainly made in the later stages. Earlier diagnosis of CKD offers the opportunity to implement guideline-based interventions sooner, thereby delaying disease-progression and improving patient-outcomes. Inside CKD, using validated, patient-level microsimulation, aims to estimate benefits of investing in screening strategies to diagnose CKD in 10 years’ timeline.

METHODS: The microsimulation model constructs a virtual baseline population from currently available Belgium-specific data on demographics, CKD status, comorbidities, all-cause mortality, and associated costs. Two hypothetical screening strategies were compared to “current scenario”: i) 2 estimated glomerular filtration rate (eGFR) tests and ii) 2 eGFR tests + 1 urinary albumin-to-creatine ratio (UACR) test. The “current scenario” reflects the present situation of lower diagnoses in Belgium as reported in literature. The model projects cost-effectiveness of these strategies from 2022 to 2032, across the full CKD population (≥ 45 years) and several subgroups at high risk: type-2 diabetes, hypertension, cardiovascular disease, and age ≥ 65 years.

RESULTS: The implementation of both screening programs increased the diagnosis rate by 21.8% from 2022 to 2032. Compared to the “current scenario” for the full CKD population, the 2eGFR only strategy showed incremental cost-effectiveness ratios (ICERs) of 5,925.88 €/QALY which further decreased to 5,143.73 €/QALY when adding a UACR test to the 2eGFR only. Furthermore, when assessed only in high-risk subgroups, the ICERs lower down substantially up to ~3,000€/QALY.

CONCLUSIONS: Both screening strategies are cost-effective in 10-year timeline for the Belgian healthcare system, considering a willingness-to-pay equal to Belgian gross domestic product per capita (i.e., approx. 43,300 €). Implementation of continuous screening, preferably UACR test in addition to 2eGFR tests in primary care, particularly for high-risk subgroups, may lead to timely and optimal treatment delaying CKD progression, improving patient outcomes, and subsequently reducing healthcare burden.