Long-term cost-effectiveness of CKD screening in middle-aged adults

Background and Hypothesis Chronic kidney disease (CKD) is common in Finland and frequently remains undiagnosed until advanced stages. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) slow CKD progression and reduce cardio-renal events when used in addition to Renin-Angiotensin-Aldosterone System inhibitor (RAASi) treatment. We hypothesized that a one-time CKD screening program using measurements of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), followed by SGLT2i and RAASi treatment for identified CKD, would be cost-effective in Finland. Methods We developed a cohort-based Markov model to simulate lifetime CKD progression in a Finnish cohort aged 55 years under two strategies: (1) current practice (no screening) and (2) one-time screening with follow-up and SGLT2i and RAASi treatment for screen-positive CKD (eGFR <60 mL/min/1.73 m² and/or UACR ≥3 mg/mmol; confirmed on a repeat sample after ≥ 3 months to establish chronicity). All CKD stages (G1–G5, dialysis, transplant, and death) were included in the model, and screening could detect CKD at any stage, although the incremental detection was concentrated in earlier, previously undiagnosed stages (G1–G3). Outcomes included discounted costs, quality-adjusted life years (QALYs), life years, and clinical outcomes (acute kidney function decline, heart-failure hospital days, dialysis and transplant patient-years, and deaths). Results are reported as means with 95% confidence intervals (CI). Results Screening increased discounted lifetime costs per person by €907 (95% CI €334–2 553) and QALYs by 0.14 (95% CI 0.07–0.31), yielding an incremental cost-effectiveness ratio of €6 478/QALY. Screening increased life years by 0.30. Screening reduced acute kidney function decline (0.88 vs 0.90 events/person), heart-failure hospital days (6.47 vs 6.69 days/person), dialysis exposure (0.29 vs 0.32 patient-years/person) and transplant exposure (0.13 vs 0.14 patient-years/person). Conclusions In Finns aged 55 years, one-time CKD screening with eGFR/UACR followed by SGLT2i and RAASi treatment improves long-term outcomes and is likely cost-effective.