The study modelled one-time chronic kidney disease (CKD) screening in a simulated Finnish cohort aged 55. A Markov model compared no screening with eGFR and UACR screening plus SGLT2i and RAASi treatment. Screening added €907 per person in discounted lifetime costs (95% CI €334–2,553). It added 0.14 quality-adjusted life years (QALYs) (95% CI 0.07–0.31) and 0.30 life years, at €6,478 per QALY. Dialysis exposure fell from 0.32 to 0.29 patient-years per person, and heart-failure hospital days from 6.69 to 6.47. The results come from a simulation, not observed screening outcomes, and rest on the model's assumptions.
Why it is interesting: Most extra cases found by screening were previously undiagnosed early CKD, stages G1 to G3. The modelled gains include fewer heart-failure hospital days as well as less dialysis.
Abstract — the authors' own words, CC BY
Background and hypothesis
Chronic kidney disease (CKD) is common in Finland and frequently remains undiagnosed until advanced stages. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) slow CKD progression and reduce cardio-renal events when used in addition to Renin-Angiotensin-Aldosterone System inhibitor (RAASi) treatment. We hypothesized that a one-time CKD screening program using measurements of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), followed by SGLT2i and RAASi treatment for identified CKD, would be cost-effective in Finland. Methods
We developed a cohort-based Markov model to simulate lifetime CKD progression in a Finnish cohort aged 55 years under two strategies: (1) current practice (no screening) and (2) one-time screening with follow-up and SGLT2i and RAASi treatment for screen-positive CKD (eGFR Results
Screening increased discounted lifetime costs per person by €907 (95% CI €334-2 553) and QALYs by 0.14 (95% CI 0.07-0.31), yielding an incremental cost-effectiveness ratio of €6 478/QALY. Screening increased life years by 0.30. Screening reduced acute kidney function decline (0.88 vs 0.90 events/person), heart-failure hospital days (6.47 vs 6.69 days/person), dialysis exposure (0.29 vs 0.32 patient-years/person) and transplant exposure (0.13 vs 0.14 patient-years/person). Conclusions
In Finns aged 55 years, one-time CKD screening with eGFR/UACR followed by SGLT2i and RAASi treatment improves long-term outcomes and is likely cost-effective.
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