Table 4.
Cost-Effectiveness of Using the Bang et al. and Kshirsagar et al. Risk Scores to Identify Persons for CKD Screening
| Screening Scenario | Means | ICER (2016 US $ per QALY) | |
|---|---|---|---|
| Lifetime Costs (2016 US $) | Lifetime QALYs | ||
| No screening | $139,200 | 21.349 | — |
| Bang et al. risk score | |||
| 1-year follow-up screening | |||
| Risk threshold = 0.20 | $139,945 (134,865, 147,248) | 21.366 (20.659, 21.915) | $43,791 per QALY |
| Risk threshold = 0.15 | $140,024 (135,020, 147,634) | 21.367 (20.660, 21.903) | $79,408 per QALY |
| Risk threshold = 0.10 | $140,152 (135,122, 147,313) | 21.370 (20.660, 21.931) | $42,645 per QALY |
| Risk threshold = 0.05 | $140,317 (134,909, 147,273) | 21.372 (20.664, 21.919) | $82,165 per QALY |
| Risk threshold = 0.02 | $140,566 (133,133, 145,052) | 21.374 (20.602, 21.826) | $124,626 per QALY |
| 2-year follow-up screening | |||
| Risk threshold = 0.20 | $139,783 (135,227, 147,465) | 21.363 (20.688, 21.912) | $41,594 per QALY |
| Risk threshold = 0.15 | $139,820 (135,201, 147,212) | 21.365 (20.664, 21.888) | $18,749 per QALY |
| Risk threshold = 0.10 | $139,880 (135,064, 147,565) | 21.368 (20.652, 21.938) | $19,852 per QALY |
| Risk threshold = 0.05 | $139,939 (134,902, 147,208) | 21.370 (20.655, 21.904) | $29,778 per QALY |
| Risk threshold = 0.02 | $139,997 (135,199, 147,283) | 21.373 (20.666, 21.923) | $19,116 per QALY |
| 5-year follow-up screening | |||
| Risk threshold = 0.20 | $139,708 (135,002, 147,573) | 21.361 (20.686, 21.898) | $42,277 per QALY |
| Risk threshold = 0.15 | $139,749 (135,108, 147,277) | 21.363 (20.666, 21.890) | $20,403 per QALY |
| Risk threshold = 0.10 | $139,775 (135,303, 147,168) | 21.366 (20.649, 21.925) | $8,823 per QALY |
| Risk threshold = 0.05 | $139,820 (134,826, 147,093) | 21.368 (20.647, 21.917) | $22,609 per QALY |
| Risk threshold = 0.02 | $139,852 (134,968, 147,288) | 21.371 (20.644, 21.924) | $10,662 per QALY |
| Kshirsagar et al. risk score | |||
| 1-year follow-up screening | |||
| Risk threshold = 0.20 | $140,073 (135,007, 147,383) | 21.366 (20.682, 21.915) | $51,316 per QALY |
| Risk threshold = 0.15 | $140,179 (135,241, 147,683) | 21.369 (20.664, 21.901) | $35,292 per QALY |
| Risk threshold = 0.10 | $140,432 (135,483, 147,257) | 21.371 (20.684, 21.916) | $126,832 per QALY |
| Risk threshold = 0.05 | $140,657 (135,057, 147,402) | 21.374 (20.648, 21.939) | $74,996 per QALY |
| Risk threshold = 0.02 | $141,063 (135,111, 147,469) | 21.375 (20.660, 21.946) | $405,861 per QALY |
| 2-year follow-up screening | |||
| Risk threshold = 0.20 | $139,807 (134,840, 147,579) | 21.363 (20.634, 21.916) | $43,328 per QALY |
| Risk threshold = 0.15 | $139,848 (135,096, 147,115) | 21.367 (20.658, 21.929) | $10,202 per QALY |
| Risk threshold = 0.10 | $139,980 (135,162, 147,227) | 21.370 (20.657, 21.899) | $44,115 per QALY |
| Risk threshold = 0.05 | $140,022 (135,378, 147,369) | 21.373 (20.708, 21.909) | $13,970 per QALY |
| Risk threshold = 0.02 | $140,131 (134,999, 147,385) | 21.374 (20.689, 21.918) | $109,186 per QALY |
| 5-year follow-up screening | |||
| Risk threshold = 0.20 | $139,705 (135,092, 147,340) | 21.361 (20.670, 21.893) | $42,001 per QALY |
| Risk threshold = 0.15 | $139,744 (135,192, 147,309) | 21.365 (20.659, 21.917) | $9,926 per QALY |
| Risk threshold = 0.10 | $139,828 (135,188, 147,368) | 21.367 (20.704, 21.887) | $41,910 per QALY |
| Risk threshold = 0.05 | $139,853 (134,908, 147,298) | 21.371 (20.651, 21.947) | $6,342 per QALY |
| Risk threshold = 0.02 | $139,879 (134,675, 147,422) | 21.372 (20.653, 21.925) | $25,366 per QALY |
CKD chronic kidney disease, ICER incremental cost-effectiveness ratio, QALYs quality adjusted life years. Notes: 95% confidence intervals are in parentheses. Costs have been rounded to the nearest dollar, and QALYS have been rounded to the nearest thousandth. The Bang et al. risk score is derived from a logistic regression to predict current CKD (stage 3+) in the NHANES population. The Kshirsagar et al. risk score is derived from a logistic regression to predict onset of CKD (stage 3+) over the 9-year study period in subsamples of ARIC and the Cardiovascular Health Study (CHS). Coefficients used to generate the risk scores are given in Table 3