Introduction
Methods
Objective The study aims to assess the cost-effectiveness of population strategy, i.e. mass screening, for CKD control and Japan’s health checkup reform |
Methods Cost-effectiveness analysis was carried out to compare test modalities in the context of reforming Japan’s mandatory annual health checkup for adults. A decision tree and Markov model with societal perspective were constructed to compare dipstick test to check proteinuria only, serum creatinine (Cr) assay only, or both |
Results Number of screened patients and incremental cost-effectiveness ratios (ICERs) of mass screening compared with do-nothing were calculated as 832 patients out of 100,000 participants and ¥1,139,399/QALY (US $12,660/QALY) for dipstick test only; 3,448 patients and ¥8,122,492/QALY (US $90,250/QALY) for serum Cr assay only; and 3,898 patients and ¥8,235,431/QALY (US $91,505/QALY) for both. Number of additionally screened patients and ICERs associated with the reform were calculated as 1,061 (3,898 from 2,837) patients out of 100,000 participants and ¥9,325,663/QALY (US $103,618/QALY) for mandating serum Cr assay in addition to the currently used mandatory dipstick test (Policy 1), and 611 (3,448 from 2,837) patients ¥9,001,414/QALY (US $100,016/QALY) for mandating serum Cr assay and applying dipstick test at discretion (Policy 2). The decrease of new haemodialysis patients compared with do-nothing in the fifth year and tenth year were estimated as 0.293 %/1.128 % for dipstick test only, 5.092 %/4.380 % for serum Cr assay only, and 5.094 %/4.380 % for both. The decrease of new haemodialysis patients associated with the reform was 1.249 %/1.346 % for Policy 1 and 1.251 %/1.346 % for Policy 2 |
Conclusions Taking a threshold to judge cost-effectiveness according to World Health Organization’s recommendation, i.e. three times gross domestic product per capita of ¥11.5 million/QALY (US $128 thousand/QALY), a policy that mandates serum Cr assay is cost-effective. The choice of continuing the current policy which mandates dipstick test only is also cost-effective. Results suggest that a population strategy for CKD detection such as mass screening using dipstick test and/or serum Cr assay can be justified as an efficient use of health care resources in a population with high prevalence of the disease |
1. The annual economic model is good for 15 years | ||
2. Annual budgets per person (costs in the economic model [12]) | ||
Screening | ||
Dipstick test only | ¥ 267 (¥267) | |
Serum Cr assay only | ¥138 (¥138) | |
Dipstick test and serum Cr assay | ¥342 (¥342) | |
Detailed examination at clinic or hospital | ¥17,500 (¥25,000) | |
CKD treatment | ||
Stage 1 | ¥84,000 (¥120,000) | |
Stage 2 | ¥102,900 (¥147,000) | |
Stage 3 | ¥235,900 (¥337,000) | |
Stage 4 | ¥555,100 (¥793,000) | |
Stage 5 | ¥691,600 (¥988,000) | |
ESRD treatment | ¥5,880,000 (¥6,000,000) | |
Heart attack treatment | ||
1st year | ¥1,946,000 (¥2,780,000) | |
2nd year and after | ¥125,300 (¥179,000) | |
Stroke treatment | ||
1st year | ¥700,000 (¥1,000,000) | |
2nd year and after | ¥125,300 (¥179,000) | |
3. A population projection for Japan [17] is used and sex and age structure is applied for the annual economic model | ||
4. The uptake of SHC is fixed at 41.3 % for 15 years [18] |
Results
Year | Budget impact: total additional expenditure (¥, million) | Additional expenditure for screening (¥, million) | Additional expenditure for curative care (¥, million) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Dipstick test only | Serum Cr assay only | Dipstick test and serum Cr assay | Status quo | Dipstick test only | Serum Cr assay only | Dipstick test and serum Cr assay | Status quo | Dipstick test only | Serum Cr assay only | Dipstick test and serum Cr assay | Status quo | |
1st (2012) | 79 | 2,505 | 2,517 | 1,542 | 16 | 8 | 20 | 18 | 64 | 2,497 | 2,497 | 1,524 |
2nd (2013) | −96 | 3,295 | 3,308 | 1,946 | 16 | 8 | 20 | 18 | −112 | 3,287 | 3,288 | 1,928 |
3rd (2014) | −278 | 3,972 | 3,985 | 2,280 | 16 | 8 | 20 | 18 | −294 | 3,964 | 3,965 | 2,262 |
4th (2015) | −454 | 4,561 | 4,574 | 2,563 | 16 | 8 | 20 | 18 | −470 | 4,553 | 4,554 | 2,545 |
5th (2016) | −615 | 5,089 | 5,103 | 2,815 | 16 | 8 | 20 | 18 | −631 | 5,081 | 5,083 | 2,797 |
6th (2017) | −755 | 5,572 | 5,586 | 3,049 | 16 | 8 | 20 | 18 | −771 | 5,564 | 5,566 | 3,031 |
7th (2018) | −872 | 6,025 | 6,039 | 3,274 | 16 | 8 | 20 | 18 | −887 | 6,017 | 6,019 | 3,256 |
8th (2019) | −964 | 6,453 | 6,467 | 3,494 | 16 | 8 | 20 | 18 | −979 | 6,445 | 6,447 | 3,476 |
9th (2020) | −1,032 | 6,861 | 6,875 | 3,712 | 16 | 8 | 20 | 18 | −1,048 | 6,853 | 6,855 | 3,693 |
10th (2021) | −1,079 | 7,261 | 7,275 | 3,933 | 16 | 8 | 20 | 18 | −1,094 | 7,252 | 7,255 | 3,915 |
11th (2022) | −1,105 | 7,660 | 7,675 | 4,162 | 16 | 8 | 20 | 18 | −1,120 | 7,652 | 7,655 | 4,144 |
12th (2023) | −1,114 | 8,060 | 8,076 | 4,399 | 16 | 8 | 20 | 18 | −1,129 | 8,052 | 8,056 | 4,380 |
13th (2024) | −1,109 | 8,456 | 8,472 | 4,638 | 16 | 8 | 20 | 18 | −1,124 | 8,448 | 8,452 | 4,620 |
14th (2025) | −1,092 | 8,845 | 8,861 | 4,878 | 16 | 8 | 20 | 18 | −1,108 | 8,837 | 8,841 | 4,860 |
15th (2026) | −1,067 | 9,235 | 9,251 | 5,122 | 16 | 8 | 20 | 18 | −1,083 | 9,227 | 9,231 | 5,104 |
Year | Budget impact: total additional expenditure (¥, million) | Additional expenditure for screening (¥, million) | Additional expenditure for curative care (¥, million) | |||
---|---|---|---|---|---|---|
Policy 1: mandate serum Cr assay | Policy 2: mandate serum Cr assay and abandon dipstick test | Policy 1: mandate serum Cr assay | Policy 2: mandate serum Cr assay and abandon dipstick test | Policy 1: mandate serum Cr assay | Policy 2: mandate serum Cr assay and abandon dipstick test | |
1st (2012) | 975 | 963 | 2 | −10 | 973 | 973 |
2nd (2013) | 1,362 | 1,349 | 2 | −10 | 1,360 | 1,359 |
3rd (2014) | 1,705 | 1,692 | 2 | −10 | 1,704 | 1,702 |
4th (2015) | 2,011 | 1,998 | 2 | −10 | 2,010 | 2,008 |
5th (2016) | 2,287 | 2,274 | 2 | −10 | 2,285 | 2,284 |
6th (2017) | 2,537 | 2,523 | 2 | −10 | 2,535 | 2,533 |
7th (2018) | 2,765 | 2,751 | 2 | −10 | 2,763 | 2,761 |
8th (2019) | 2,973 | 2,958 | 2 | −10 | 2,971 | 2,969 |
9th (2020) | 3,164 | 3,149 | 2 | −10 | 3,162 | 3,159 |
10th (2021) | 3,342 | 3,328 | 2 | −10 | 3,341 | 3,338 |
11th (2022) | 3,513 | 3,498 | 2 | −10 | 3,511 | 3,508 |
12th (2023) | 3,677 | 3,662 | 2 | −10 | 3,675 | 3,672 |
13th (2024) | 3,833 | 3,818 | 2 | −10 | 3,832 | 3,828 |
14th (2025) | 3,983 | 3,967 | 2 | −10 | 3,981 | 3,977 |
15th (2026) | 4,129 | 4,113 | 2 | −10 | 4,127 | 4,123 |