PDF(Pubmed)
Abstract：
UNASSIGNED: Chronic kidney disease (CKD) is a significant public health problem, with rising incidence and prevalence worldwide, and is associated with increased morbidity and mortality. Early identification and treatment of CKD can slow its progression and prevent complications, but it is not clear whether CKD screening is cost-effective. The aim of this study is to conduct a systematic review of the cost-effectiveness of CKD screening strategies in general adult populations worldwide, and to identify factors, settings and drivers of cost-effectiveness in CKD screening.
UNASSIGNED: Studies examining the cost-effectiveness of CKD screening in the general adult population were identified by systematic literature search on electronic databases (MEDLINE OVID, Embase, Cochrane Library and Web of Science) for peer-reviewed publications, hand-searched reference lists and grey literature of relevant sites, focusing on the following themes: (i) CKD, (ii) screening and (iii) cost-effectiveness. Studies comprising health economic evaluations performed for CKD screening strategies, compared with no CKD screening or usual-care strategy in adult individuals, were included. Study characteristics, model assumptions and CKD screening strategies of selected studies were identified. The primary outcome of interest is the incremental cost-effectiveness ratio (ICER) of CKD screening, in cost per quality-adjusted life year (QALY) and life-year gained (LYG), expressed in 2022 US dollars equivalent.
UNASSIGNED: Twenty-one studies were identified, examining CKD screening in general and targeted populations. The cost-effectiveness of screening for CKD was found to vary widely across different studies, with ICERs ranging from $113 to $430 595, with a median of $26 662 per QALY and from $6516 to $38 372, with a median of $29 112 per LYG. Based on the pre-defined cost-effectiveness threshold of $50 000 per QALY, the majority of the studies found CKD screening to be cost-effective. CKD screening was especially cost-effective in those with diabetes ($113 to $42 359, with a median of $27 471 per QALY) and ethnic groups identified to be higher risk of CKD development or progression ($23 902 per QALY in African American adults and $21 285 per QALY in Canadian indigenous adults), as indicated by a lower ICER. Additionally, the cost-effectiveness of CKD screening improved if it was performed in older adults, populations with higher CKD risk scores, or when setting a higher albuminuria detection threshold or increasing the interval between screening. In contrast, CKD screening was not cost-effective in populations without diabetes and hypertension (ICERs range from $117 769 to $1792 142, with a median of $202 761 per QALY). Treatment effectiveness, prevalence of CKD, cost of CKD treatment and discount rate were identified to be the most common influential drivers of the ICERs.
UNASSIGNED: Screening for CKD is especially cost-effective in patients with diabetes and high-risk ethnic groups, but not in populations without diabetes and hypertension. Increasing the age of screening, screening interval or albuminuria detection threshold, or selection of population based on CKD risk scores, may increase cost-effectiveness of CKD screening, while treatment effectiveness, prevalence of CKD, cost of CKD treatment and discount rate were influential drivers of the cost-effectiveness.
UNASSIGNED: Studies examining the cost-effectiveness of CKD screening in the general adult population were identified by systematic literature search on electronic databases (MEDLINE OVID, Embase, Cochrane Library and Web of Science) for peer-reviewed publications, hand-searched reference lists and grey literature of relevant sites, focusing on the following themes: (i) CKD, (ii) screening and (iii) cost-effectiveness. Studies comprising health economic evaluations performed for CKD screening strategies, compared with no CKD screening or usual-care strategy in adult individuals, were included. Study characteristics, model assumptions and CKD screening strategies of selected studies were identified. The primary outcome of interest is the incremental cost-effectiveness ratio (ICER) of CKD screening, in cost per quality-adjusted life year (QALY) and life-year gained (LYG), expressed in 2022 US dollars equivalent.
UNASSIGNED: Twenty-one studies were identified, examining CKD screening in general and targeted populations. The cost-effectiveness of screening for CKD was found to vary widely across different studies, with ICERs ranging from $113 to $430 595, with a median of $26 662 per QALY and from $6516 to $38 372, with a median of $29 112 per LYG. Based on the pre-defined cost-effectiveness threshold of $50 000 per QALY, the majority of the studies found CKD screening to be cost-effective. CKD screening was especially cost-effective in those with diabetes ($113 to $42 359, with a median of $27 471 per QALY) and ethnic groups identified to be higher risk of CKD development or progression ($23 902 per QALY in African American adults and $21 285 per QALY in Canadian indigenous adults), as indicated by a lower ICER. Additionally, the cost-effectiveness of CKD screening improved if it was performed in older adults, populations with higher CKD risk scores, or when setting a higher albuminuria detection threshold or increasing the interval between screening. In contrast, CKD screening was not cost-effective in populations without diabetes and hypertension (ICERs range from $117 769 to $1792 142, with a median of $202 761 per QALY). Treatment effectiveness, prevalence of CKD, cost of CKD treatment and discount rate were identified to be the most common influential drivers of the ICERs.
UNASSIGNED: Screening for CKD is especially cost-effective in patients with diabetes and high-risk ethnic groups, but not in populations without diabetes and hypertension. Increasing the age of screening, screening interval or albuminuria detection threshold, or selection of population based on CKD risk scores, may increase cost-effectiveness of CKD screening, while treatment effectiveness, prevalence of CKD, cost of CKD treatment and discount rate were influential drivers of the cost-effectiveness.
摘要：
■慢性肾脏病（CKD）是一个重大的公共卫生问题，随着全球发病率和患病率的上升，并与发病率和死亡率增加有关。早期识别和治疗CKD可以减缓其进展并预防并发症，但目前尚不清楚CKD筛查是否具有成本效益。这项研究的目的是对全世界一般成人人群中CKD筛查策略的成本效益进行系统评价。并确定因素，CKD筛查成本效益的设置和驱动因素。
■通过在电子数据库上进行系统的文献检索，确定了在普通成人人群中进行CKD筛查的成本效益研究（MEDLINEOVID，Embase,Cochrane图书馆和WebofScience)用于同行评审的出版物，相关网站的手工搜索参考列表和灰色文献，重点关注以下主题：(I)CKD，（ii）筛查和（iii）成本效益。包括针对CKD筛查策略进行的健康经济学评估的研究，与成年人没有CKD筛查或常规护理策略相比，包括在内。研究特点，确定了选定研究的模型假设和CKD筛查策略。感兴趣的主要结果是CKD筛查的增量成本效益比(ICER)，在每个质量调整寿命年(QALY)和获得寿命年(LYG)的成本中，以2022年等值美元表示。
■确定了21项研究，检查一般人群和目标人群的CKD筛查。CKD筛查的成本效益在不同的研究中差异很大，ICER从113美元到430595美元不等，每个QALY的中位数为26662美元，从6516美元到38372美元不等，每个LYG的中位数为29112美元。基于每个QALY50000美元的预定义成本效益阈值，大多数研究发现CKD筛查具有成本效益.CKD筛查在糖尿病患者中具有特别的成本效益（$113至$42359，每个QALY的中位数为$27471），并且种族群体被确定为CKD发展或进展的风险较高（非裔美国成年人的每个QALY为$23902，加拿大土著成年人的每个QALY为$21285）。正如较低的ICER所示。此外,如果在老年人中进行，CKD筛查的成本效益会提高，CKD风险评分较高的人群，或设置更高的蛋白尿检测阈值或增加筛查间隔。相比之下,在没有糖尿病和高血压的人群中，CKD筛查并不具有成本效益（ICER的范围为$117769至$1792142，每个QALY的中位数为$202761）。治疗效果,CKD患病率,CKD治疗成本和折现率被确定为ICER最常见的影响因素.
■CKD筛查在糖尿病患者和高危人群中尤其具有成本效益，但不是在没有糖尿病和高血压的人群中。增加筛查年龄，筛查间隔或蛋白尿检测阈值，或根据CKD风险评分选择人群，可能会增加CKD筛查的成本效益，虽然治疗有效，CKD患病率,CKD治疗成本和折现率是成本效益的影响因素.
■通过在电子数据库上进行系统的文献检索，确定了在普通成人人群中进行CKD筛查的成本效益研究（MEDLINEOVID，Embase,Cochrane图书馆和WebofScience)用于同行评审的出版物，相关网站的手工搜索参考列表和灰色文献，重点关注以下主题：(I)CKD，（ii）筛查和（iii）成本效益。包括针对CKD筛查策略进行的健康经济学评估的研究，与成年人没有CKD筛查或常规护理策略相比，包括在内。研究特点，确定了选定研究的模型假设和CKD筛查策略。感兴趣的主要结果是CKD筛查的增量成本效益比(ICER)，在每个质量调整寿命年(QALY)和获得寿命年(LYG)的成本中，以2022年等值美元表示。
■确定了21项研究，检查一般人群和目标人群的CKD筛查。CKD筛查的成本效益在不同的研究中差异很大，ICER从113美元到430595美元不等，每个QALY的中位数为26662美元，从6516美元到38372美元不等，每个LYG的中位数为29112美元。基于每个QALY50000美元的预定义成本效益阈值，大多数研究发现CKD筛查具有成本效益.CKD筛查在糖尿病患者中具有特别的成本效益（$113至$42359，每个QALY的中位数为$27471），并且种族群体被确定为CKD发展或进展的风险较高（非裔美国成年人的每个QALY为$23902，加拿大土著成年人的每个QALY为$21285）。正如较低的ICER所示。此外,如果在老年人中进行，CKD筛查的成本效益会提高，CKD风险评分较高的人群，或设置更高的蛋白尿检测阈值或增加筛查间隔。相比之下,在没有糖尿病和高血压的人群中，CKD筛查并不具有成本效益（ICER的范围为$117769至$1792142，每个QALY的中位数为$202761）。治疗效果,CKD患病率,CKD治疗成本和折现率被确定为ICER最常见的影响因素.
■CKD筛查在糖尿病患者和高危人群中尤其具有成本效益，但不是在没有糖尿病和高血压的人群中。增加筛查年龄，筛查间隔或蛋白尿检测阈值，或根据CKD风险评分选择人群，可能会增加CKD筛查的成本效益，虽然治疗有效，CKD患病率,CKD治疗成本和折现率是成本效益的影响因素.
