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Early identification of kidney disease cost-effective only when directed at high-risk patients

g proved highly favorable, at a cost of $18,621 per QALY. Such screening resulted in 196 kidney biopsies, seven complications from biopsies and complication costs of $200,000, with the prevention of approximately 14 new cases of end-stage renal disease and 104 deaths per million people per year.

"Physicians must incorporate a variety of considerations into decisions regarding early disease detection," Boulware adds. "When taking into account the kidney disease-slowing benefits for people with neither hypertension nor diabetes, who have low incidence and prevalence of proteinuria, regular screening averts very few ESRD cases and prevents few deaths. The resulting minimal gain in QALYs is too small to balance the costs of such testing."

The study also found that urine protein testing in the general population became more cost-effective when annual screening was initiated at age 60, at a cost of $53,372 per QALY. In addition, screening also made financial sense when done every 10 years. The estimated costs were $80,700 per QALY at age 50, $6,195 per QALY at age 60 and $5,486 per QALY at age 70.

Continuing research will use the computer program to look at the cost-effectiveness of screening other populations, such as African Americans (who have high rates of hypertension and diabetes), and to study other factors in kidney disease management, Boulware says.


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Contact: Karen Blum
kblum@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
16-Dec-2003


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