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Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective.
- Source :
-
Kidney international [Kidney Int] 2017 Jul; Vol. 92 (1), pp. 192-200. Date of Electronic Publication: 2017 Apr 20. - Publication Year :
- 2017
-
Abstract
- Canadian indigenous (First Nations) have rates of kidney failure that are 2- to 4-fold higher than the non-indigenous general Canadian population. As such, a strategy of targeted screening and treatment for CKD may be cost-effective in this population. Our objective was to assess the cost utility of screening and subsequent treatment for CKD in rural Canadian indigenous adults by both estimated glomerular filtration rate and the urine albumin-to-creatinine ratio. A decision analytic Markov model was constructed comparing the screening and treatment strategy to usual care. Primary outcomes were presented as incremental cost-effectiveness ratios (ICERs) presented as a cost per quality-adjusted life-year (QALY). Screening for CKD was associated with an ICER of $23,700/QALY in comparison to usual care. Restricting the model to screening in communities accessed only by air travel (CKD prevalence 34.4%), this ratio fell to $7,790/QALY. In road accessible communities (CKD prevalence 17.6%) the ICER was $52,480/QALY. The model was robust to changes in influential variables when tested in univariate sensitivity analyses. Probabilistic sensitivity analysis found 72% of simulations to be cost-effective at a $50,000/QALY threshold and 93% of simulations to be cost-effective at a $100,000/QALY threshold. Thus, targeted screening and treatment for CKD using point-of-care testing equipment in rural Canadian indigenous populations is cost-effective, particularly in remote air access-only communities with the highest risk of CKD and kidney failure. Evaluation of targeted screening initiatives with cluster randomized controlled trials and integration of screening into routine clinical visits in communities with the highest risk is recommended.<br /> (Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Albuminuria diagnosis
Albuminuria economics
Albuminuria ethnology
Aviation
Computer Simulation
Cost-Benefit Analysis
Decision Support Techniques
Early Diagnosis
Female
Humans
Male
Manitoba epidemiology
Markov Chains
Mass Screening methods
Middle Aged
Models, Economic
Motor Vehicles
Point-of-Care Testing economics
Predictive Value of Tests
Prevalence
Prognosis
Quality-Adjusted Life Years
Renal Insufficiency, Chronic ethnology
Renal Insufficiency, Chronic therapy
Time Factors
Health Care Costs
Health Services, Indigenous economics
Indians, North American
Mass Screening economics
Renal Insufficiency, Chronic diagnosis
Renal Insufficiency, Chronic economics
Rural Health Services economics
Subjects
Details
- Language :
- English
- ISSN :
- 1523-1755
- Volume :
- 92
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Kidney international
- Publication Type :
- Academic Journal
- Accession number :
- 28433383
- Full Text :
- https://doi.org/10.1016/j.kint.2017.02.022