Can a semi-quantitative method replace the current quantitative method for the annual screening of microalbuminuria in patients with diabetes? Diagnostic accuracy and cost-saving analysis considering the potential health burden

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  Fig 1. Structure of the Markov model. The square denotes a decision node where the quantitative or semi-quantitative screening strategy can be chosen. The circles represent chance nodes in which subsequent events occur at probabilities allocated to each node. The letter M in a circle indicates a Markov node. The triangles represent terminal nodes, where subjects return to the Markov node from which they started the cycle and start the next cycle again. Descriptions accompanying terminal nodes designate the path for the subjects to follow at the next Markov cycle. * Annual probabilities of these clinical events were derived from diabetic patients with normo-albuminuria. ** Putatively, both true negative and false negative fractions are present in the SemiQ negative population. The occurrences from both cases were included. For the population with false negatives, the hazard ratio for clinical outcomes was assessed in micro- or overt albuminuric diabetic patients. Additionally, for the population with true negative results, the hazard ratio for clinical outcomes was assessed in normo-albuminuric diabetic patients. Abbreviations: CVD, cardiovascular disease; DM, diabetes mellitus; ESRD,…

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  Fig 2. Relative hazard ratios for major clinical outcomes such as death, cardiovascular disease, and end-stage renal disease in diabetic patients with albuminuria and eGFR ≥60 ml/min/1.73 m2 compared to normo-albuminuric diabetic patients. Abbreviations: CVD, cardiovascular disease; CI, confidence interval; ESRD, end-stage renal disease; HR, hazard ratio.

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  Fig 3. Tornado diagram of one-way sensitivity analyses. The vertical dashed line indicates the value in the base case analysis. Black bars represent the deviation resulting from the increase in corresponding input values. Gray bars represent the deviation resulting from the decrease in corresponding input values. * Incidences of clinical outcomes were converted to annual probabilities in the Markov model. ** Hazard ratios for clinical outcomes among diabetic patients (micro-or overt albuminuria versus normo-albuminuria). The values were used to calculate incidences of clinical outcomes in diabetic patients with micro- or overt albuminuria. Abbreviations: CVD, cardiovascular disease; ESRD, end-stage renal disease; HR, hazard ratio; Q test, quantitative test; SemiQ test, semi-quantitative test.