Cost-Effectiveness Analysis of Screening Chronic Kidney Disease in Iran

• Main Authors: Hamid Ravaghi, Ali Farzaneh, Mehdi Ebrahimnia, Zohreh Rostami, Mohammad Hasan Hashemi madani
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2019-11-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: insurance; qaly index; mass screening
• Online Access: https://jcdr.net/articles/PDF/13295/42446_CE[Ra1]_F(KM)_PF1(AG_SHU)_PFA(SHU)_PB(AG_SHU)_PN(SL).pdf

Introduction: The prevalence of Chronic Kidney Disease (CKD) in Iran amounts to 15.14%, which is higher than the global average. Given the substantial cost of this disease, health insurance companies need evidence of the cost-effectiveness of screening for the disease in adults at risk so that they can control the prevalence of the disease and the associated incremental medical costs by implementing a nationwide screening. Aim: To explore the cost-effectiveness of screening for CKD among adults as compared with having a non-intervention strategy. Materials and Methods: The study had a cross-sectional design and uses the cost-effectiveness analysis approach to compare the costs and outcomes of screening versus nonscreening CKD. The estimated Glomerular Filtration Rate (GFR) was used for primary screening of the population. For this purpose, blood creatinine was measured; subsequently, urine creatinine and volume were analysed. However, some complementary measures and diagnostic tests were employed for positive cases, including the kidney ultrasonography. Costs and outcomes of the two strategies was calculated using a Markov decision model. This model is designed based on the natural course of CKD and GFR as a five-stage model. Costs of services required for patients were calculated based on Iran Health Insurance Organisation database, and outcome data were extracted in terms of the Quality-Adjusted Life-Year (QALY) index. Using TreeAge software, costs and outcomes were simulated for 1000 patients, and sensitivity analysis was used to test the reliability of the model data. Results: For an adult population, the cost-effectiveness ratio for screening versus non-screening was 277,686,954 Rials per QALY, which was the effective cost. The results of one-way sensitivity analysis on the variables of the model shows that the screening strategy can be considered a dominant strategy in different domains. Conclusion: Given the high prevalence of CKD in Iran, early detection of this disease via adult population screening is cost-effective for health insurance companies, and these organisations can control the costs of dialysis and kidney transplantation by reducing the rate of patient transitions from early to the final stages of the disease.