Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategies
Abstract Background Chronic kidney disease (CKD) places a significant health burden on developing countries such as Iran. Early diagnosis and management of CKD, even when asymptomatic, can improve patient outcomes. The objective of this study was to evaluate the cost-effectiveness of CKD screening p...
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| Format: | Article |
| Language: | English |
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BMC
2025-06-01
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| Series: | Renal Replacement Therapy |
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| Online Access: | https://doi.org/10.1186/s41100-025-00645-4 |
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| author | Fatemeh Keshvari-Shad Mahmood Yousefi Sakineh Haj Ebrahimi Alireza Mahboub-Ahari Nastaran Nemati Satar Rezaei |
| author_facet | Fatemeh Keshvari-Shad Mahmood Yousefi Sakineh Haj Ebrahimi Alireza Mahboub-Ahari Nastaran Nemati Satar Rezaei |
| author_sort | Fatemeh Keshvari-Shad |
| collection | DOAJ |
| description | Abstract Background Chronic kidney disease (CKD) places a significant health burden on developing countries such as Iran. Early diagnosis and management of CKD, even when asymptomatic, can improve patient outcomes. The objective of this study was to evaluate the cost-effectiveness of CKD screening programs in Iran. Methods A decision-analytic Markov model was used to compare five CKD screening strategies, including (1) estimated glomerular filtration rate (eGFR); (2) urine albumin-to-creatinine ratio (ACR); (3) urine albumin concentration (UAC); (4) urine dipstick proteinuria testing; and (5) no screening among the general population aged 40–80 years: The analysis was conducted from the Iranian healthcare system’s perspective over a lifetime horizon, with a 1-year Markov cycle length. Future costs and health outcomes were discounted at an annual rate of 3.5%. Model input parameters were extracted from published literature and local Iranian data where available. The incremental cost-effectiveness ratios (ICERs) were used to compare the cost and outcome of different strategies. Probabilistic sensitivity analysis (PSA) was conducted to assess the impact of total uncertainty on the results. Results Our analysis found that all four screening programs increased quality-adjusted life years (QALYs) compared with no screening. The eGFR screening strategy had the highest QALYs among all strategies, while the no screening strategy had the highest costs. Using a willingness-to-pay threshold of IRR 316,112,349 (US $3276.8) per QALY, the model suggests that the ACR, eGFR, and dipstick screening strategies were superior to no screening, offering lower costs and more QALYs over the 40-year period. Probabilistic sensitivity analysis confirmed the robustness of these base-case findings. Conclusions The current study demonstrated that screening for chronic kidney disease is cost-effective in the Iranian healthcare system while reducing costs and increasing QALYs. This economic analysis provides evidence to support implementing a screening program for chronic kidney disease management in Iran. |
| format | Article |
| id | doaj-art-2e2f2bd8c071407f8ef669155079a3a5 |
| institution | Kabale University |
| issn | 2059-1381 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Renal Replacement Therapy |
| spelling | doaj-art-2e2f2bd8c071407f8ef669155079a3a52025-08-20T03:46:24ZengBMCRenal Replacement Therapy2059-13812025-06-011111910.1186/s41100-025-00645-4Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategiesFatemeh Keshvari-Shad0Mahmood Yousefi1Sakineh Haj Ebrahimi2Alireza Mahboub-Ahari3Nastaran Nemati4Satar Rezaei5Sina (Farshchian) Hospital, Hamadan University of Medical SciencesResearch Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical SciencesResearch Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence, Faculty of Medicine, Tabriz University of Medical SciencesDepartment of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical SciencesDepartment of Health Management and Policy, University of KentuckyResearch Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical SciencesAbstract Background Chronic kidney disease (CKD) places a significant health burden on developing countries such as Iran. Early diagnosis and management of CKD, even when asymptomatic, can improve patient outcomes. The objective of this study was to evaluate the cost-effectiveness of CKD screening programs in Iran. Methods A decision-analytic Markov model was used to compare five CKD screening strategies, including (1) estimated glomerular filtration rate (eGFR); (2) urine albumin-to-creatinine ratio (ACR); (3) urine albumin concentration (UAC); (4) urine dipstick proteinuria testing; and (5) no screening among the general population aged 40–80 years: The analysis was conducted from the Iranian healthcare system’s perspective over a lifetime horizon, with a 1-year Markov cycle length. Future costs and health outcomes were discounted at an annual rate of 3.5%. Model input parameters were extracted from published literature and local Iranian data where available. The incremental cost-effectiveness ratios (ICERs) were used to compare the cost and outcome of different strategies. Probabilistic sensitivity analysis (PSA) was conducted to assess the impact of total uncertainty on the results. Results Our analysis found that all four screening programs increased quality-adjusted life years (QALYs) compared with no screening. The eGFR screening strategy had the highest QALYs among all strategies, while the no screening strategy had the highest costs. Using a willingness-to-pay threshold of IRR 316,112,349 (US $3276.8) per QALY, the model suggests that the ACR, eGFR, and dipstick screening strategies were superior to no screening, offering lower costs and more QALYs over the 40-year period. Probabilistic sensitivity analysis confirmed the robustness of these base-case findings. Conclusions The current study demonstrated that screening for chronic kidney disease is cost-effective in the Iranian healthcare system while reducing costs and increasing QALYs. This economic analysis provides evidence to support implementing a screening program for chronic kidney disease management in Iran.https://doi.org/10.1186/s41100-025-00645-4Cost effectiveness analysisChronic kidney diseaseScreeningGeneral population |
| spellingShingle | Fatemeh Keshvari-Shad Mahmood Yousefi Sakineh Haj Ebrahimi Alireza Mahboub-Ahari Nastaran Nemati Satar Rezaei Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategies Renal Replacement Therapy Cost effectiveness analysis Chronic kidney disease Screening General population |
| title | Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategies |
| title_full | Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategies |
| title_fullStr | Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategies |
| title_full_unstemmed | Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategies |
| title_short | Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategies |
| title_sort | chronic kidney disease screening in iran a cost effectiveness analysis of different strategies |
| topic | Cost effectiveness analysis Chronic kidney disease Screening General population |
| url | https://doi.org/10.1186/s41100-025-00645-4 |
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