Development of the simulation-based German albuminuria screening model (S-GASM) for estimating the cost-effectiveness of albuminuria screening in Germany

Abstract

Background Chronic kidney disease is often asymptomatic in its early stages but constitutes a severe burden for patients and causes major healthcare systems costs worldwide. While models for assessing the cost-effectiveness of screening were proposed in the past, they often presented only a limited view. This study aimed to develop a simulation-based German Albuminuria Screening Model (S-GASM) and present some initial applications. Methods The model consists of an individual-based simulation of disease progression, considering age, gender, body mass index, systolic blood pressure, diabetes, albuminuria, glomerular filtration rate, and quality of life, furthermore, costs of testing, therapy, and renal replacement therapy with parameters based on published evidence. Selected screening scenarios were compared in a cost-effectiveness analysis. Results Compared to no testing, a simulation of 10 million individuals with a current age distribution of the adult German population and a follow-up until death or the age of 90 shows that a testing of all individuals with diabetes every two years leads to a reduction of the lifetime prevalence of renal replacement therapy from 2.5% to 2.3%. The undiscounted costs of this intervention would be 1164.10 € / QALY (quality-adjusted life year). Considering saved costs for renal replacement therapy, the overall undiscounted costs would be—12581.95 € / QALY. Testing all individuals with diabetes or hypertension and screening the general population reduced the lifetime prevalence even further (to 2.2% and 1.8%, respectively). Both scenarios were cost-saving (undiscounted, - 7127.10 €/QALY and—5439.23 €/QALY). Conclusions The S-GASM can be used for the comparison of various albuminuria testing strategies. The exemplary analysis demonstrates cost savings through albuminuria testing for individuals with diabetes, diabetes or hypertension, and for population-wide screening.

Cost-Effectiveness of Routine Monitoring of Long-Term Conditions in Primary Care: Informing Decision Modelling with a Systematic Review in Hypertension, Type 2 Diabetes and Chronic Kidney Disease

“…Based on the inclusion criteria, five studies [ 11 , 38 – 41 ] (including one NICE [ 11 ] report) were included in the final review. Twenty-one excluded studies and the reasons for their exclusion are provided in Table A1 in the Appendix; 13 studies [ 42 – 54 ] did not evaluate a laboratory-based testing strategy (self-monitoring of either blood glucose or blood pressure, or urine test strips), six studies [ 55 – 60 ] did not evaluate a testing strategy at regular intervals (one-off screening only or screening rather than monitoring, or evaluated treatment rather than monitoring) and two studies [ 61 , 62 ] assessed economic evaluation in terms of cost-saving only (not a cost-effectiveness study). Figure 1 shows a summary of the study selection process.…”

Albuminuria Screening in People With Type 2 Diabetes in a Managed Care Organization

“…A recent simulation study suggests that ALB screening can lead to lower end-stage renal disease rates and is cost effective. 30 The measures reported in this paper can help close the gap for ALB testing 31 and are not expensive to implement relative to the cost of treating progressive DKD. What is more, these measures seem to increase the representativeness of those screened and to improve diabetes care.…”

Clinical value of noninvasive lens advanced glycation end product detection in early screening and severity evaluation of patients with diabetic kidney disease

“…The exploration of early screening methods and models for DKD continues. In this field, eGFR and UACR are early laboratory markers that can be used for early screening of DKD [ 7 ]. However, clinically, DKD is susceptible to interference by human immunodeficiency virus infection, chronic liver diseases, cardiovascular diseases and other diseases, and it is difficult to measure it accurately [ 8 ].…”