Can a semi-quantitative method replace the current quantitative method for the annual screening of microalbuminuria in patients with diabetes? Diagnostic accuracy and cost-saving analysis considering the potential health burden


Autoři: Yaerim Kim aff001;  Seokwoo Park aff002;  Myung-Hee Kim aff005;  Sang Hoon Song aff006;  Won Mok Lee aff007;  Hye Soon Kim aff008;  Kyubok Jin aff001;  Seungyeup Han aff001;  Yong Chul Kim aff002;  Seung Seok Han aff002;  Hajeong Lee aff002;  Jung Pyo Lee aff002;  Kwon Wook Joo aff002;  Chun Soo Lim aff002;  Yon Su Kim aff002;  Dong Ki Kim aff002
Působiště autorů: Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea aff001;  Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea aff002;  Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea aff003;  Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea aff004;  Department of Dental Hygiene, College of Health Science, Eulji University, Gyeonggi-do, Korea aff005;  Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea aff006;  Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea aff007;  Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea aff008;  Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea aff009;  Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea aff010
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227694

Souhrn

Objectives

Diabetes is a global epidemic, and the high cost of annually and quantitatively measuring urine albumin excretion using the turbidimetric immunoassay is challenging. We aimed to determine whether a semi-quantitative urinary albumin-creatinine ratio test could be used as a screening tool for microalbuminuria in diabetic patients.

Methods

We assessed the diagnostic accuracy of the semi-quantitative method. The costs of false results in the semi-quantitative method were calculated based on the annual probability of disease progression analyzed through a systematic literature review and meta-analysis. The pooled long-term cost-saving effect of the semi-quantitative method compared with the quantitative test was assessed using a Markov model simulating a long-term clinical setting. Diagnostic accuracy and the cost-saving effect were also validated in an independent external cohort.

Results

Compared with the quantitative test, the semi-quantitative method had sensitivities of 93.5% and 81.3% and specificities of 61.4% and 63.1% in the overall sample of diabetic patients (n = 1,881) and in diabetic patients with eGFR ≥60 ml/min/1.73 m2 and a negative dipstick test (n = 1,110), respectively. After adjusting for direct and indirect medical costs, including the risk of disease progression, which was adjusted by the meta-analyzed hazard ratio for clinical outcomes, it was determined that using the semi-quantitative method could save 439.4 USD per person for 10 years. Even after adjusting the result to the external validation cohort, 339.6 USD could be saved for one diabetic patient for 10 years.

Conclusions

The semi-quantitative method could be an appropriate screening tool for albuminuria in diabetic patients. Moreover, it can minimize the testing time and inconvenience and significantly reduce national health costs.

Klíčová slova:

Albumins – Cardiovascular diseases – Creatinine – Diabetes mellitus – Health economics – Chronic kidney disease – Metaanalysis – Urine


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