Introduction
Methods
Participant cohort
Base-case value | Range tested in sensitivity analysis (%) | Source | ||||
---|---|---|---|---|---|---|
Participant cohort
| ||||||
Probability (%) | ||||||
Falling into sex and age stratum | Male | 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74 | 10.008, 9.280, 8.810, 9.783, 6.460, 5.721, 4.472 | ±50 | [13] | |
Female | 40–44, 45-49, 50–54, 55–59, 60–64, 65–69, 70–74 | 6.291, 6.054, 6.137, 7.364, 6.836, 7.143, 5.643 | ||||
Falling into initial renal function stratum | − | Stage 1, stage 2, stage 3, stage 4, stage 5 | 11.660, 46.095, 28.627, 0.224, 0.029 | ±50 | Japan Tokutei-Kenshin CKD Cohort 2008 | |
± | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.866, 3.771, 3.214, 0.056, 0.008 | ||||
1+ | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.325, 1.548, 1.779, 0.086, 0.013 | ||||
2+ | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.080, 0.385, 0.705, 0.095, 0.026 | ||||
≥3+ | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.027, 0.104, 0.204, 0.053, 0.020 | ||||
Decision tree
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Probability (%) | ||||||
Seeking detailed examination after screened as further examination required | 40.0 | ±50 | ||||
Either eGFR <50 ml/min/1.73 m2 or having comorbidity among stage 3 patients (advanced stage 3) | 83.5 | ±50 | Japan Tokutei-Kenshin CKD Cohort 2008 | |||
Starting CKD treatment after detailed examination | – | Advanced stage 3, stage 4, stage 5 | 48.9, 82.2, 96.0 | ±50 | Delphi method survey of expert committee | |
± | Advanced stage 3, stage 4, stage 5 | 51.7, 83.9, 97.1 | ||||
1+ | Stage 1, stage 2, early stage 3, advanced stage 3, stage 4, stage 5 | 25.6, 31.1, 46.7, 71.7, 92.2, 98.0 | ||||
2+ | Stage 1, stage 2, early stage 3, advanced stage 3, stage 4, stage 5 | 62.2, 68.3, 78.9, 93.2, 97.1, 99.8 | ||||
≥3+ | Stage 1, stage 2, early stage 3, advanced stage 3, stage 4, stage 5 | 93.2, 94.3, 97.1, 97.7, 99.9, 99.9 | ||||
Markov model
| ||||||
Probability (%) | ||||||
From (1) screened and/or examined to (2) ESRD with no treatment by initial renal function | – | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.001, 0.004, 0.016, 0.154, 1.743 | ±50 | Calculated from Okinawa database [18] | |
± | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.019, 0.020, 0.036, 1.137, 5.628 | ||||
1+ | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.036, 0.024, 0.303, 3.527, 15.802 | ||||
2+ | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.080, 0.305, 1.170, 10.939, 31.409 | ||||
≥3+ | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.347, 0.933, 2.506, 13.824, 69.340 | ||||
From (2) ESRD to (5) death by sex and age | Male | 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90 | 0.033, 0.034, 0.035, 0.036, 0.038, 0.039, 0.041, 0.042, 0.044, 0.045, 0.047, 0.048, 0.050, 0.052, 0.054, 0.056, 0.058, 0.060, 0.062, 0.065, 0.068, 0.071, 0.074, 0.078, 0.081, 0.084, 0.088, 0.092, 0.097, 0.101, 0.105, 0.111, 0.117, 0.123, 0.129, 0.135, 0.142, 0.148, 0.155, 0.160, 0.166, 0.176, 0.186, 0.196, 0.202, 0.208, 0.226, 0.229, 0.245, 0.288, 0.257 | ±50 | Calculated from Japanese dialysis patient registry [21] | |
Female | 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90 | 0.029, 0.030, 0.031, 0.032, 0.033, 0.034, 0.035, 0.036, 0.038, 0.039, 0.041, 0.042, 0.043, 0.045, 0.047, 0.049, 0.050, 0.052, 0.055, 0.057, 0.059, 0.062, 0.065, 0.068, 0.070, 0.074, 0.078, 0.080, 0.085, 0.089, 0.093, 0.097, 0.101, 0.105, 0.110, 0.115, 0.122, 0.127, 0.134, 0.138, 0.145, 0.151, 0.159, 0.162, 0.173, 0.185, 0.188, 0.198, 0.205, 0.219, 0.236 | ||||
From (1) screened and/or examined to (3) heart attack with no treatment by initial dipstick test result, sex and age | <1+ | Male | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 0.005, 0.041, 0.076, 0.132, 0.126, 0.068 | ±50 | [22] |
Female | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 0.019, 0.078, 0.130, 0.234, 0.275, 0.372 | ||||
≥1+ | Male | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 0.000, 0.000, 0.018, 0.033, 0.112, 0.077 | |||
Female | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 0.003, 0.010, 0.048, 0.079, 0.211, 0.224 | ||||
From (3) heart attack to (5) death by sex and age | 1st year | Male | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 2.8, 13.4, 13.0, 19.5, 33.7, 33.3 | ±50 | [22] |
Female | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 33.3, 0.0, 16.9, 25.0, 36.6, 45.8 | ||||
2nd year | Male and female | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 3.8, 3.8, 6.7, 19.5, 41.2, 100.0 | ±50 | [24] | |
From (3) heart attack/(4) stroke to (2) ESRD | 0.202 | ±50 | [27] | |||
From (1) screened and/or examined to (4) stroke with no treatment by initial dipstick test result, sex and age | <1+ | Male | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 0.026, 0.139, 0.264, 0.477, 0.738, 0.769 | ±50 | [22] |
Female | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 0.050, 0.202, 0.357, 0.655, 1.052, 1.540 | ||||
Male | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 0.014, 0.083, 0.124, 0.271, 0.508, 0.570 | ||||
Female | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 0.034, 0.133, 0.187, 0.382, 0.699, 0.905 | ||||
From (4) stroke to (5) death by sex and age | 1st year | Male | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 19.1, 14.3, 9.9, 10.6, 12.7, 18.2 | ±50 | [22] |
Female | 40–44, 45–54, 55–64, 65–74, 75–84, ≥85 | 13.6, 14.0, 13.7, 6.8, 14.8, 18.1 | ||||
2nd year | Male | 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, ≥85 | 6.8, 8.2, 9.5, 12.6, 16.6, 23.3, 37.6, 61.9, 95.1, 100.0 | ±50 | ||
Female | 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, ≥85 | 5.4, 6.4, 7.5, 9.0, 12.5, 18.4, 26.4, 40.1, 52.6, 71.7 | ||||
From (1) screened and/or examined to (5) death by sex and age | Male | 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 90–94, 95–99, 100 | 0.002, 0.003, 0.004, 0.007, 0.010, 0.015, 0.024, 0.042, 0.070, 0.119, 0.196, 0.284, 0.397 | ±50 | [28] | |
Female | 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 90–94, 95–99, 100 | 0.001, 0.001, 0.002, 0.003, 0.004, 0.006, 0.010, 0.019, 0.036, 0.070, 0.132, 0.213, 0.327 | ||||
Effectiveness of treatment (%) | ||||||
Reduction of transition probabilities from (1) screened and/or examined to (2) ESRD with treatment of CKD | 42.1 | ±50 | [20] | |||
Reduction of transition probabilities from (1) screened and/or examined to (3) heart attack with treatment of CKD | 71.0 | ±50 | [23] | |||
Reduction of transition probabilities from (1) screened and/or examined to (4) stroke with treatment of CKD | 69.3 | ±50 | [23] | |||
Quality of life adjustment
| ||||||
Utility weight | ||||||
(1) Screened and/or examined | Stage 1, stage 2, stage 3, stage 4, stage 5 | 0.940, 0.918, 0.883, 0.839, 0.798 | ±20 | [31] | ||
(2) ESRD | 0.658 | ±20 | [32] | |||
(3) Heart attack | 0.771 | |||||
(4) Stroke | 0.714 | |||||
Costing
| ||||||
Annual cost per person (¥) | ||||||
Screening | Dipstick test only, serum Cr assay only, dipstick test and serum Cr | 267, 138, 342 | ±50 | Survey of health checkup service providers | ||
Detailed examination | 25,000 | ±50 | Expert opinion | |||
CKD treatment | Stage 1, stage 2, stage 3, stage 4, stage 5 | 120,000, 147,000, 337,000, 793,000, 988,000 | ±50 | Expert opinion | ||
ESRD treatment | 6,000,000 | ±50 | [33] | |||
Heart attack treatment | 1st year, 2nd year | 2,780,000, 179,000 | ±50 | [34] | ||
Stroke treatment | 1st year, 2nd year | 1,000,000, 179,000 | ±50 | [34] |
Decision tree
Markov model
Quality of life adjustment
Costing
Discounting
Policy options for economic evaluation
Sensitivity analysis
Results
Model estimators
No. of patients per 100,000 participants | Cost (¥) | Incremental cost (¥) | Effectiveness (QALY) | Incremental effectiveness (QALY) | Incremental cost-effectiveness ratio (¥/QALY) | |
---|---|---|---|---|---|---|
Do-nothing | 0 | 2,125,490 | 16.11639 | |||
(a) Dipstick test only | 832 | 2,132,778 | 7,288 | 16.12278 | 0.00639 | 1,139,399 |
(b) Serum Cr assay only | 3,448 | 2,515,492 | 390,002 | 16.16440 | 0.04801 | 8,122,492 |
(c) Dipstick test and serum Cr assay | 3,898 | 2,521,145 | 395,655 | 16.16443 | 0.04804 | 8,235,431 |
Cost-effectiveness
No. of patients per 100,000 participants | Cost (¥) | Incremental cost (¥) | Effectiveness (QALY) | Incremental effectiveness (QALY) | Incremental cost-effectiveness ratio (¥/QALY) | |
---|---|---|---|---|---|---|
Status quo | 2,837 | 2,365,798 | 16.14777 | |||
Policy 1: requiring serum Cr assay | 3,898 | 2,521,145 | 155,347 | 16.16443 | 0.01666 | 9,325,663 |
Policy 2: requiring serum Cr assay and abandoning dipstick test | 3,448 | 2,515,492 | 149,694 | 16.16440 | 0.01663 | 9,001,414 |
Stability of cost-effectiveness
Discussion
Mandate use of serum Cr assay in addition to the current dipstick test in the next revision of SHC |