OBJECTIVES: Albuminuria has been proven to be associated with renal disease progression and cardiovascular (CV) events. Limited evidence exists on the cost-effectiveness of screening the general population for elevated albuminuria. The aim of this study was to estimate the cost-effectiveness of various ‘screen-and-treat’ scenarios. METHODS: A multi-state Markov model was developed to simulate ‘natural course’ albuminuria-based progression to dialysis and occurrence of CV-events. Transition probabilities were derived from data of the PREVEND study, an observational, general population-based cohort study. In the base-case analysis, cost-effectiveness was estimated for screening the general population on microalbuminuria (pre-screening on first morning void urinary albumin concentration ≥20 mg/L and confirmation in two 24-hr urine samples with urinary albumin excretion ≥30 mg). Cost of screening and ACE-inhibitor treatment minus savings on dialysis and CV-events was divided by life-years gained (LYG) over a 8-years time-horizon, to render the cost-effectiveness ratio for the base-case microalbuminuria screening and alternative scenarios. Costs (2008 values) and effects were discounted at 4% and 1.5%, respectively. RESULTS: Among 1000 subjects identified with microalbuminuria, 76 versus 124 CV-events, 16 versus 27 CV-deaths and 3 versus 5 dialysis cases were found for simulating screening and treatment versus no screening, respectively. The per-person cost of screening was calculated at €926 (€2,003 versus €1,077) and prevention of CV-deaths was estimated to gain 0.0421 per-person discounted life years, resulting in a cost-effectiveness of €22,000 per LYG. The probability of accepting screening for microalbuminuria with maximum willingness-to-pay thresholds of €20,000, €50,000, and €80,000 per LYG, was estimated at 54%, 90% and 95%, respectively. Limiting screening to subjects aged >50 or >60 even improved cost-effectiveness. Incremental analyses suggest a most optimal cost-effectiveness of screening for microalbuminuria. CONCLUSIONS: Our current analyses suggest most favorable cost-effectiveness of screening for microalbuminuria if compared with other evaluated alternative albuminuria-based scenarios.