Background
Methods
Model overview
Model Parameter | Parameter Value | Source |
---|---|---|
Sensitivity of screening test for moderate albuminuria | 0.73 | Sarafidis et al. [23] |
Specificity of screening test for moderate albuminuria | 0.96 | Sarafidis et al. [23] |
Treatment adherence of persons diagnosed with moderate albuminuria | 0.75 | Boulware et al. [14] |
Treatment effect relative risks (multiplied by baseline rates) | ||
Relative risk of moderate- to severe albuminuria transition for persons receiving treatment | 0.45 | Strippoli et al. [6] |
Relative risk of mortality for persons with moderate albuminuria receiving treatment | 0.77 | Boulware et al. [14] |
Relative risk of annual GFR decrease in persons with for persons with moderate albuminuria receiving treatment | 0.67 | |
Annual QALY decrement from CKD and related complications | ||
Proteinuria | 0.01 | Gorodetskaya et al. [24] |
GFR 30–59 | 0.05 | Gorodetskaya et al. [24] |
GFR 15–29 | 0.07 | Gorodetskaya et al. [24] |
GFR <15 | 0.20 | Gorodetskaya et al. [24] |
Stroke, ever | 0.582 | Meenan et al. [25] |
CA/MI, current year | 0.12 | Tsevat et al. [26] |
CHD, ever without MI | 0.053 | Nease et al. [27] |
Screening costs (2016 US $) | ||
Initial visit | 88.58 | CMS [28] |
Second visit if positive during first visit | 69.08 | CMS [28] |
One time costs of diagnostic tests to assess for CKD if GFR <60 ml/min/1.73 m2 (2010 $) | ||
Diabetes or hypertension | 382.41 | |
Neither hypertension nor diabetes: Severe albuminuria and age < 65 | 2,857.10 | |
Neither hypertension nor diabetes: Moderate albuminuria and age <65 | 1,401.40 | |
Neither hypertension nor diabetes: Age ≥65 | 964.69 | |
Annual follow-up costs if GFR <60 ml/min/1.73 m2 (2016 US $) | ||
Specialist visit: | ||
Diabetes | 94.15 | |
No diabetes | 85.23 | |
General practitioner visit | 132.88 | |
Annual drug therapy | ||
ARBs (diabetes) | 527.49 | |
ACE inhibitors (no diabetes) | 210.03 | |
Annual rate at which costs and QALYs are discounted (i.e. reduced) | 3% | Weinstein et al. [21] |
Costs
Risk scores
Risk Score | No Risk Factors | Diabetes | Diabetes and Hypertension | Diabetes, Hypertension, and Anemia | Cardiovascular Disease |
---|---|---|---|---|---|
Bang et al. | |||||
Female: Age < 50 | 0.01 | 0.01 | 0.01 | 0.04 | 0.06 |
Female: Age 50 to 59 | 0.03 | 0.04 | 0.06 | 0.15 | 0.24 |
Female: Age 60 to 69 | 0.06 | 0.09 | 0.13 | 0.27 | 0.40 |
Female: Age ≥ 70 | 0.13 | 0.19 | 0.27 | 0.49 | 0.63 |
Male: Age < 50 | 0.00 | 0.01 | 0.01 | 0.03 | 0.05 |
Male: Age 50 to 59 | 0.02 | 0.03 | 0.05 | 0.12 | 0.19 |
Male: Age 60 to 69 | 0.04 | 0.07 | 0.10 | 0.22 | 0.34 |
Male: Age ≥ 70 | 0.10 | 0.15 | 0.22 | 0.41 | 0.56 |
Kshirsagar et al. | |||||
Female: Age < 50 | 0.04 | 0.06 | 0.09 | 0.14 | 0.18 |
Female: Age 50 to 59 | 0.07 | 0.10 | 0.16 | 0.24 | 0.28 |
Female: Age 60 to 69 | 0.14 | 0.18 | 0.28 | 0.38 | 0.45 |
Female: Age ≥ 70 | 0.15 | 0.20 | 0.30 | 0.41 | 0.48 |
Male: Age < 50 | 0.04 | 0.05 | 0.08 | 0.13 | 0.16 |
Male: Age 50 to 59 | 0.06 | 0.09 | 0.14 | 0.21 | 0.26 |
Male: Age 60 to 69 | 0.12 | 0.16 | 0.25 | 0.35 | 0.41 |
Male: Age ≥ 70 | 0.14 | 0.18 | 0.28 | 0.38 | 0.45 |
Individual Characteristic | Bang et al. Risk Score Coefficient [15] | Kshirsagar et al. Risk Score Coefficient [16] |
---|---|---|
Age (Reference: 18 to 49) | ||
50 to 59 | 1.55 | 0.63 |
60 to 69 | 2.31 | 1.33 |
70+ | 3.23 | 1.46 |
Female | 0.29 | 0.13 |
Diabetes | 0.44 | 0.33 |
Hypertensiona
| 0.45 | 0.55 |
Anemiab
| 0.93 | 0.48 |
Proteinuriac
| 0.83 | - |
History of cardiovascular disease | 0.59 | 0.26 |
History of congestive heart failure | 0.45 | 0.50 |
Constant | −5.40 | −3.30 |
Incremental cost-effectiveness ratios
Model validation
Sensitivity analysis
Results
Screening Scenario | Means | ICER (2016 US $ per QALY) | |
---|---|---|---|
Lifetime Costs (2016 US $) | Lifetime QALYs | ||
No screening | $139,200 | 21.349 | — |
Bang et al. risk score | |||
1-year follow-up screening | |||
Risk threshold = 0.20 | $139,945 (134,865, 147,248) | 21.366 (20.659, 21.915) | $43,791 per QALY |
Risk threshold = 0.15 | $140,024 (135,020, 147,634) | 21.367 (20.660, 21.903) | $79,408 per QALY |
Risk threshold = 0.10 | $140,152 (135,122, 147,313) | 21.370 (20.660, 21.931) | $42,645 per QALY |
Risk threshold = 0.05 | $140,317 (134,909, 147,273) | 21.372 (20.664, 21.919) | $82,165 per QALY |
Risk threshold = 0.02 | $140,566 (133,133, 145,052) | 21.374 (20.602, 21.826) | $124,626 per QALY |
2-year follow-up screening | |||
Risk threshold = 0.20 | $139,783 (135,227, 147,465) | 21.363 (20.688, 21.912) | $41,594 per QALY |
Risk threshold = 0.15 | $139,820 (135,201, 147,212) | 21.365 (20.664, 21.888) | $18,749 per QALY |
Risk threshold = 0.10 | $139,880 (135,064, 147,565) | 21.368 (20.652, 21.938) | $19,852 per QALY |
Risk threshold = 0.05 | $139,939 (134,902, 147,208) | 21.370 (20.655, 21.904) | $29,778 per QALY |
Risk threshold = 0.02 | $139,997 (135,199, 147,283) | 21.373 (20.666, 21.923) | $19,116 per QALY |
5-year follow-up screening | |||
Risk threshold = 0.20 | $139,708 (135,002, 147,573) | 21.361 (20.686, 21.898) | $42,277 per QALY |
Risk threshold = 0.15 | $139,749 (135,108, 147,277) | 21.363 (20.666, 21.890) | $20,403 per QALY |
Risk threshold = 0.10 | $139,775 (135,303, 147,168) | 21.366 (20.649, 21.925) | $8,823 per QALY |
Risk threshold = 0.05 | $139,820 (134,826, 147,093) | 21.368 (20.647, 21.917) | $22,609 per QALY |
Risk threshold = 0.02 | $139,852 (134,968, 147,288) | 21.371 (20.644, 21.924) | $10,662 per QALY |
Kshirsagar et al. risk score | |||
1-year follow-up screening | |||
Risk threshold = 0.20 | $140,073 (135,007, 147,383) | 21.366 (20.682, 21.915) | $51,316 per QALY |
Risk threshold = 0.15 | $140,179 (135,241, 147,683) | 21.369 (20.664, 21.901) | $35,292 per QALY |
Risk threshold = 0.10 | $140,432 (135,483, 147,257) | 21.371 (20.684, 21.916) | $126,832 per QALY |
Risk threshold = 0.05 | $140,657 (135,057, 147,402) | 21.374 (20.648, 21.939) | $74,996 per QALY |
Risk threshold = 0.02 | $141,063 (135,111, 147,469) | 21.375 (20.660, 21.946) | $405,861 per QALY |
2-year follow-up screening | |||
Risk threshold = 0.20 | $139,807 (134,840, 147,579) | 21.363 (20.634, 21.916) | $43,328 per QALY |
Risk threshold = 0.15 | $139,848 (135,096, 147,115) | 21.367 (20.658, 21.929) | $10,202 per QALY |
Risk threshold = 0.10 | $139,980 (135,162, 147,227) | 21.370 (20.657, 21.899) | $44,115 per QALY |
Risk threshold = 0.05 | $140,022 (135,378, 147,369) | 21.373 (20.708, 21.909) | $13,970 per QALY |
Risk threshold = 0.02 | $140,131 (134,999, 147,385) | 21.374 (20.689, 21.918) | $109,186 per QALY |
5-year follow-up screening | |||
Risk threshold = 0.20 | $139,705 (135,092, 147,340) | 21.361 (20.670, 21.893) | $42,001 per QALY |
Risk threshold = 0.15 | $139,744 (135,192, 147,309) | 21.365 (20.659, 21.917) | $9,926 per QALY |
Risk threshold = 0.10 | $139,828 (135,188, 147,368) | 21.367 (20.704, 21.887) | $41,910 per QALY |
Risk threshold = 0.05 | $139,853 (134,908, 147,298) | 21.371 (20.651, 21.947) | $6,342 per QALY |
Risk threshold = 0.02 | $139,879 (134,675, 147,422) | 21.372 (20.653, 21.925) | $25,366 per QALY |