Screening for XXXX in US adults: a cost-effectiveness analysis.

@entity1 @entity644 @entity1289 @entity101 @entity6 @entity740 @entity204
CONTEXT: @entity740 is a growing public health problem. Screening for early identification could improve health but could also lead to unnecessary harms and excess costs. OBJECTIVE: To assess the value of periodic, population-based dipstick screening for early detection of urine protein in adults with neither @entity101 nor @entity6 and in adults with @entity101 . DESIGN, SETTING, AND POPULATION: Cost-effectiveness analysis using a Markov decision analytic model to compare a strategy of annual screening with no screening (usual care) for @entity644 at age 50 years followed by treatment with an @entity1289 ( @entity1289 ) inhibitor or an angiotensin II-receptor blocker (ARB). MAIN OUTCOME MEASURE: Cost per quality-adjusted life-year (QALY). RESULTS: For @entity1 with neither @entity101 nor @entity6 , the cost-effectiveness ratio for screening vs no screening (usual care) was unfavorable (282 818 dollars per QALY; incremental cost of 616 dollars and a gain of 0.0022 QALYs per @entity1 ). However, screening such @entity1 beginning at age 60 years yielded a more favorable ratio (53 372 dollars per QALY). For @entity1 with @entity101 , the ratio was highly favorable (18 621 dollars per QALY; incremental cost of 476 dollars and a gain of 0.03 QALYs per @entity1 ). Cost-effectiveness was mediated by both @entity740 progression and @entity204 prevention benefits of @entity1289 inhibitor and ARB therapy. Influential parameters that might make screening for the general population more cost-effective include a greater incidence of @entity644 , age at screening (53 372 dollars per QALY for @entity1 beginning screening at age 60 years), or lower frequency of screening (every 10 years: 80 700 dollars per QALY at age 50 years; 6195 dollars per QALY at age 60 years; and 5486 dollars per QALY at age 70 years). CONCLUSIONS: Early detection of urine protein to slow progression of @entity740 and decrease mortality is not cost-effective unless selectively directed toward high-risk groups (older @entity1 and @entity1 with @entity101 ) or conducted at an infrequent interval of 10 years.
