Abstract: TH-PO992
Cost-Effectiveness of Home-Based Screening for Albuminuria in the General Population in the Netherlands
Session Information
- CKD Epidemiology, Risk Factors, Prevention - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- van Mil, Dominique, University Medical Centre Groningen, Department of Nephrology, Groningen, Netherlands
- Pouwels, Xavier Glv, University of Twente, Health Technology and Services Research Department, Enschede, Netherlands
- Kieneker, Lyanne M., University Medical Centre Groningen, Department of Nephrology, Groningen, Netherlands
- van Etten, Ronald W., Amphia Hospital, Department of Internal Medicine, Breda, Netherlands
- Evers-Roeten, Birgitte M., General Practice Tholos, Zevenbergen, Netherlands
- Thelen, Marc, Amphia Hospital, Result Laboratory for Clinical Chemistry, Breda, Netherlands
- Hemmelder, Marc H., Maastricht University Medical Centre, Department of Internal Medicine, Maastricht, Netherlands
- Gansevoort, Ron T., University Medical Centre Groningen, Department of Nephrology, Groningen, Netherlands
- Koffijberg, Hendrik, University of Twente, Health Technology and Services Research Department, Enschede, Netherlands
Background
Screening the general population for albuminuria may identify individuals at high risk of chronic kidney disease (CKD) events and cardiovascular disease (CVD) and allow early preventive interventions. Previous studies on the cost-effectiveness of albuminuria population screening were inconclusive, modelled screening by family physicians, and included only CKD events. We evaluated the cost-effectiveness of home-based general population screening for increased albuminuria to prevent CKD and also CVD events.
Methods
We developed an individual-level health-state transition model to assess cost-effectiveness from the Dutch healthcare perspective with a lifetime horizon. Inputs were based on the THOMAS study, a prospective study in which we screened the general population aged 45-80 years, published in Lancet 2023. THOMAS consisted of a home-based albuminuria screening and subsequent elaborate screening of individuals with elevated albuminuria for CKD and CVD risk factors, to be treated by their family physicians. Risks of CKD and CVD events were calculated by simulating albuminuria and eGFR progression and the SCORE2 algorithm. Treatment relative risk reduction, quality of life weights, resource use, and cost inputs were obtained from the literature. Outcomes included the number of events, total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of screening versus usual care (no screening), based on probabilistic analysis.
Results
The relative reduction in lifetime dialysis, kidney transplantation, non-fatal myocardial infarction, non-fatal stroke, and fatal CVD events of screening was respectively 11%, 12%, 6%, 5%, and 2%. The incremental costs and QALYs of screening were €1,584 and 0.18 QALYs. This resulted in an ICER of €8.689/QALY, which would be considered cost-effective at the Dutch willingness to pay threshold of €20.000/QALY. The probability of screening being cost-effective for this threshold was 96%. Screening was more cost-effective in subjects aged 65-80 years, compared to those aged 45-65, and if implementation of care after screening was improved.
Conclusion
Home-based screening for increased albuminuria to prevent cardiovascular and chronic kidney disease events is likely cost-effective.
Funding
- Private Foundation Support