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Cost‐effectiveness of Screening for Microalbuminuria Using Immunochemical Dipstick Tests or Laboratory Assays in Diabetic Patients
Author(s) -
Floch J.P.,
Charles M.A.,
Philippon C.,
Perlemuter L.
Publication year - 1994
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1994.tb00285.x
Subject(s) - dipstick , microalbuminuria , medicine , predictive value , predictive value of tests , gastroenterology , urine , urology , renal function
To analyse the cost‐effectiveness ratio of screening for microalbuminuria in diabetic patients using either dipstick tests or laboratory assays, 506 diabetic patients were screened for microalbuminuria using both a traditional laboratory assay (strategy I) or a laboratory assay only in the case of a positive dipstick result (strategy II). Dipstick pre‐screening was considered positive if at least one of the tests performed by the two different operators showed an albumin excretion rate > 20 μg min −1 . It was performed using a new dipstick, Micral‐Test®, designed to distinguish low albumin concentrations. Biological assay was the reference method. Costs were related to laboratory assays (strategy I) or to dipstick tests and laboratory assays for positive results (strategy II). The loss of effectiveness was related to false negative results of strategy II. The double dipstick pre‐screening showed a sensitivity of 90.8% and a specificity of 80.1%. Its predictive value was 97% for a negative result and 55.6% for a positive result. False positive results were associated with elevated urinary volumes. Compared with strategy I, strategy II showed a sensitivity of 90.8%, a specificity of 100%, and predictive values of 100% and 97.5%, respectively, for positive and negative results. In a fictitious cohort of 10000 patients, strategy II yielded a gain of £16 750 on the first year, which decreased to £5345 after 30 years. The loss in effectiveness was estimated at 2.38 quality adjusted life years of a diabetic patient (QALY d ) initially, and decreased to 0.91 QALY d after 30 years, the annual cost‐effectiveness ratio being close to £6600 QALY d −1 . Sensitivity analysis found that frequency of false negative results, prevalence, and annual incidence of microalbuminuria were the most important factors likely to influence the cost‐effectiveness ratio. These results suggest that strategy II can be especially cost‐effective: (1) for annual screening in diabetic patients with urinary excretion < 2 ml min −1 and exposed to a low risk of microalbuminuria; (2) for frequent screening in patients exposed to a high risk of microalbuminuria.