Document Detail

Cost-effectiveness of screening for microalbuminuria among African Americans.
MedLine Citation:
PMID:  23204444     Owner:  NLM     Status:  MEDLINE    
Compared with other racial groups, African Americans have a similar prevalence of CKD but are much more likely to progress to ESRD, suggesting that the cost-effectiveness of screening strategies requires dedicated study in this population. Here, we calibrated the CKD Health Policy Model so that it accurately forecasts the higher rates for ESRD observed for African Americans. We then used the calibrated model to estimate the cost-effectiveness of screening for microalbuminuria followed by treatment with angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers. Incorporating racial differences in risk factors did not fully explain the much higher lifetime incidence of ESRD among African Americans. Thus, to calibrate the model, we applied a 20% increase in the rate of GFR decline at stage 3 and a 60% increase in the rate of GFR decline at stage 4, which resulted in a model that closely reflects lifetime ESRD incidence among African Americans. Compared with usual care, screening African Americans for microalbuminuria at 10-, 5-, 2-, and 1-year intervals had incremental cost-effectiveness ratios of $9000, $11,000, $19,000, and $35,000 per quality-adjusted life year, respectively. Incremental cost-effectiveness ratios for the same screening intervals were higher for non-African Americans: $17,000, $23,000, $44,000, and $81,000 per quality-adjusted life year, respectively. In summary, these models suggest that screening African Americans for microalbuminuria at either 5- or 10-year intervals is highly cost-effective.
Thomas J Hoerger; John S Wittenborn; Xiaohui Zhuo; Meda E Pavkov; Nilka R Burrows; Paul Eggers; Regina Jordan; Sharon Saydah; Desmond E Williams
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  23     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-03     Completed Date:  2013-02-04     Revised Date:  2013-12-04    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2035-41     Citation Subset:  IM    
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MeSH Terms
African Americans / statistics & numerical data*
Albuminuria / diagnosis*,  economics,  ethnology
Cost-Benefit Analysis
Disease Progression
Kidney Failure, Chronic / economics,  ethnology*
Mass Screening* / economics
Middle Aged
Models, Theoretical
Comment In:
J Am Soc Nephrol. 2012 Dec;23(12):1915-6   [PMID:  23160510 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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