Background Chronic kidney disease (CKD) is a significant public health problem. Strategy for its early detection is still controversial. This study aims to assess the costeffectiveness of population strategy, i.e. mass screening, and Japan's health checkup reform. Methods Cost-effectiveness analysis was carried out to compare test modalities in the context of reforming Japan's mandatory annual health checkup for adults. A decision tree and Markov model with societal perspective were constructed to compare dipstick test to check proteinuria only, serum creatinine (Cr) assay only, or both. Results Incremental cost-effectiveness ratios (ICERs) of mass screening compared with do-nothing were calculated as Y1,139,399/QALY (US 12,660/QALY) for dipstick test only, Y8,122,492/QALY (US 90,250/QALY) for serum Cr assay only and Y8,235,431/QALY (US 91,505/ QALY) for both. ICERs associated with the reform were calculated as Y9,325,663/QALY (US 103,618/QALY) for mandating serum Cr assay in addition to the currently used mandatory dipstick test, and Y9,001,414/QALY (US 100, 016/QALY) for mandating serum Cr assay and applying dipstick test at discretion. Conclusions Taking a threshold to judge cost-effectiveness according to World Health Organization's recommendation, i.e. three times gross domestic product per capita of Y11.5 million/QALY (US 128 thousand/QALY), a policy that mandates serum Cr assay is cost-effective. The choice of continuing the current policy which mandates dipstick test only is also cost-effective. Our results suggest that a population strategy for CKD detection such as mass screening using dipstick test and/or serum Cr assay can be justified as an efficient use of health care resources in a population with high prevalence of the disease such as in Japan and Asian countries.
All Science Journal Classification (ASJC) codes
- Physiology (medical)