Urine Screening Cost-Effective for Diabetics, Hypertensives

NASHVILLE—Periodically testing a patient’s urine for low levels of protein (microalbuminuria) is cost-effective in people with diabetes and hypertension, two strong risk factors for chronic kidney disease (CKD), according to research presented at the National Kidney Foundation’s Spring Clinical Meeting.

“Previous research has shown that screening for high levels of urine protein (macroalbuminuria) is cost-effective for people with diabetes and may be cost-effective for people with hypertension,” said co-investigator Thomas Hoerger, PhD. “We elected to study whether it is also cost-effective to introduce screening for microalbuminuria, which is an earlier and much more prevalent indicator of CKD.”

Hoerger, at RTI International in Research Triangle Park, North Carolina, is the director of the RTI-UNC Center of Excellence in Health Promotion Economics.

Cost-effectiveness of such medical screening depends on numerous factors, he explained, such as progression rates, complication rates and treatment compliance and effectiveness.

He and his colleagues developed a mathematical model to assess costs associated with CKD, which also incorporated data regarding risk factors (including diabetes, hypertension, smoking and high cholesterol) and complications such as cardiovascular disease, as well as costs for microalbuminuria testing and treatment with drugs called ACE inhibitors and angiotensin II-receptor blockers.

According to their results, “initiating annual screening for microalbuminuria is cost-effective for people with diabetes from age 30 to 80,” Hoerger reported. “However, annual screening of people with hypertension and no diabetes was only cost-effective if begun right around age 50. Annual screening of people with neither diabetes nor hypertension was not cost-effective when introduced at any age.”

This research was sponsored by the Centers for Disease Control and Prevention (CDC), as part of the CDC CKD Initiative. The CDC contracted with RTI to develop a model for use in ongoing cost-effectiveness research.

“As other promising interventions become available for CKD, we will be able to use the model to analyze their cost-effectiveness,” said Dr. Desmond Williams, who leads the CDC CKD Initiative and is a study co-author.