Document Detail


The costs and benefits of automatic estimated glomerular filtration rate reporting.
MedLine Citation:
PMID:  19176794     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: The prevalence of chronic kidney disease (CKD) has increased over the past two decades. The sensitivity of serum creatinine (sCr) to identify CKD is low. As a result, many healthcare centers report estimated GFR (eGFR) with routine blood work. The aim of this study was to determine the cost-effectiveness of automatic eGFR reporting compared with reporting sCr alone.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A Markov model was designed to evaluate the cost-effectiveness of reporting eGFR compared with reporting sCr alone in a hypothetical cohort of 60-yr-old individuals undergoing annual blood chemistry testing over 18 yr. Paths and path probabilities were identical between the two arms, except for the sensitivity and specificity of eGFR and sCr to detect CKD.
RESULTS: eGFR reporting was dominant with a cost/effectiveness ratio of $16,751/quality-adjusted life year (QALY) versus $16,779/QALY for sCr reporting. Monte Carlo microsimulations in a hypothetical cohort of 10,000 patients demonstrated that over 18 yr, an average of 13 fewer deaths, 29 fewer ESRD events, and 11,348 more false positive CKD (FP-CKD) cases occurred with eGFR reporting. A sensitivity analysis revealed that decreasing the FP-CKD quality of life by > 2% rendered sCr reporting more cost-effective than eGFR reporting. If FP-CKD reduced quality of life by 5%, the incremental cost-effectiveness ratio for sCr reporting versus eGFR reporting would be $4367/QALY.
CONCLUSION: A decision analysis suggests that reporting eGFR may be beneficial, but this limited benefit was reversed with virtually any reduction in quality of life caused by incorrect diagnosis of CKD.
Authors:
Julia R den Hartog; Peter P Reese; Borut Cizman; Harold I Feldman
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article     Date:  2009-01-28
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  4     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-16     Completed Date:  2009-06-11     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  419-27     Citation Subset:  IM    
Affiliation:
Internal Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
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MeSH Terms
Descriptor/Qualifier:
Chronic Disease
Computer Simulation
Cost-Benefit Analysis
Creatinine / blood*
Decision Support Techniques
Disease Progression
False Positive Reactions
Glomerular Filtration Rate*
Humans
Kidney Diseases / complications,  diagnosis*,  economics,  mortality
Kidney Failure, Chronic / economics,  etiology*,  mortality
Kidney Function Tests / economics*
Mandatory Programs / economics*
Mandatory Reporting*
Markov Chains
Middle Aged
Models, Economic
Monte Carlo Method
Predictive Value of Tests
Program Evaluation
Quality-Adjusted Life Years
Sensitivity and Specificity
Chemical
Reg. No./Substance:
60-27-5/Creatinine
Comments/Corrections

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