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Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective
- Source :
- Kidney international. 92(1)
- Publication Year :
- 2016
-
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.
- Subjects :
- Male
Time Factors
Cost-Benefit Analysis
030232 urology & nephrology
law.invention
0302 clinical medicine
Randomized controlled trial
law
Prevalence
Mass Screening
030212 general & internal medicine
health care economics and organizations
education.field_of_study
Cost–benefit analysis
Manitoba
Health Care Costs
Middle Aged
Prognosis
Markov Chains
Motor Vehicles
Models, Economic
Nephrology
Point-of-Care Testing
Female
Quality-Adjusted Life Years
Adult
medicine.medical_specialty
Point-of-care testing
Population
Disease cluster
Decision Support Techniques
03 medical and health sciences
Predictive Value of Tests
Environmental health
medicine
Albuminuria
Health Services, Indigenous
Humans
Computer Simulation
Renal Insufficiency, Chronic
Intensive care medicine
education
Mass screening
business.industry
medicine.disease
Quality-adjusted life year
Early Diagnosis
Indians, North American
Rural Health Services
business
Aviation
Kidney disease
Subjects
Details
- ISSN :
- 15231755
- Volume :
- 92
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Kidney international
- Accession number :
- edsair.doi.dedup.....7ef471d2461cd05b706597be4d101b6b