Abstract
Background: Chronic kidney disease (CKD) is prevalent in Thialand that incure high healthcare expenditure. Screening for high risk CKD is recommended to contribute benefit. Aging is one of a CKD risk factor, though this service is yet excluded from the Universal Coveragre Benefit Package (UCBP). Objective: To propose a recommendation for elderly CKD screening to be included in the UCBP by performing economic evaluation, budget impact analysis, and feasibility of delivery such a service. Methods: A cost-effectiveness analysis (CEA) of six screening methods was carried from societal and provider perspective. Decision-tree and markov model were used to simulate screening and CKD health states. Screening methods included Serum creatinine (Scr), Proteinuria dipstick (Pro), Microalbuminuria dipstick (Micro), Albumin-to-creatinine ratio (ACR) dipstick (ACRdip), combined Pro+Scr, and combined Micro+Scr. Parameters were reviewed and analysed by meta-analysis. Sensitivity and threshold analysis were performed to identify uncertaintity of the CEA results. Budget impact analysis was conducted to estimate 5-year budget for NHSO. Feasibility of service delivery was explored by qualitative approach using telephone interview. Results: Under Thailand’s willingness to pay of 160,000 baht/QALY, the six screening methods were cost-effective. CKD screening incurred additional cost and effectiveness. ICER of the six methods were between 16,878.73 - 24,245.37 and 13,844.74-20,503.14 baht/QALY for societal and provider perspective, respectively. Protienuria dipstick had the lowest ICER and exhibited a 5-years-budget of 5,653 million baht for screening and treatment, however treatment budget was the major proportion of the budget (97-99%). Primary care practitioners agreed the benefit of CKD screening and suggest to implement a screening method that ease to use. Preparing for CKD screening before implementation should concern: human resources, training about screening, CKD related services and referral system, educate elderly about CKD to increase compliance to screening and treatment. Conclusion: Annual CKD screening for elderly is cost-effective. Although protienuria dipstick incures the lowest budget to NHSO for screening and treatment. However microalbuminuria dipstick should be selected because of its highest cost-effectiveness. Elderly CKD screening is feasible for primary care but need some prepations regarding healthcare resources: human resources, CKD related services and referral system. This study recommends that CKD Annual CKD screening for elderly should be included in the UCBP.
