Methods Used in Economic Evaluations of Chronic Kidney Disease Testing — A Systematic Review

Background
The prevalence of chronic kidney disease (CKD) is high in general populations around the world. Targeted testing and screening for CKD are often conducted to help identify individuals that may benefit from treatment to ameliorate or prevent their disease progression.
Aims
This systematic review examines the methods used in economic evaluations of testing and screening in CKD, with a particular focus on whether test accuracy has been considered, and how analysis has incorporated issues that may be important to the patient, such as the impact of testing on quality of life and the costs they incur.
Methods
Articles that described model-based economic evaluations of patient testing interventions focused on CKD were identified through the searching of electronic databases and the hand searching of the bibliographies of the included studies.
Results
The initial electronic searches identified 2,671 papers of which 21 were included in the final review. Eighteen studies focused on proteinuria, three evaluated glomerular filtration rate testing and one included both tests. The full impact of inaccurate test results was frequently not considered in economic evaluations in this setting as a societal perspective was rarely adopted. The impact of false positive tests on patients in terms of the costs incurred in re-attending for repeat testing, and the anxiety associated with a positive test was almost always overlooked. In one study where the impact of a false positive test on patient quality of life was examined in sensitivity analysis, it had a significant impact on the conclusions drawn from the model.
Conclusion
Future economic evaluations of kidney function testing should examine testing and monitoring pathways from the perspective of patients, to ensure that issues that are important to patients, such as the possibility of inaccurate test results, are properly considered in the analysis.

背景
全球普通人群中慢性肾脏病（chronic kidney disease, CKD）的患病率居高不下。临床常针对慢性肾脏病开展针对性检测与筛查，以识别有望通过治疗缓解或延缓疾病进展的个体。

研究目的
本系统综述旨在梳理慢性肾脏病检测与筛查的经济学评价研究方法，重点关注此类研究是否考量了检测准确性，以及分析过程如何纳入对患者而言至关重要的相关问题——例如检测对患者生活质量的影响，以及患者需承担的检测相关成本。

研究方法
本研究通过电子数据库检索与纳入研究参考文献的手工检索，筛选出针对慢性肾脏病患者检测干预的基于模型的经济学评价相关文献。

研究结果
初始电子检索共获取2671篇文献，最终纳入21篇进行综述。其中18项研究聚焦于蛋白尿检测，3项评估肾小球滤过率检测，1项同时涵盖两类检测。由于此类经济学评价极少采用社会视角，因此往往未充分考虑检测结果不准确所带来的全部影响。假阳性检测导致患者需复诊进行重复检测所产生的成本，以及阳性结果伴随的焦虑情绪，几乎从未被纳入考量。在一项通过敏感性分析探究假阳性检测对患者生活质量影响的研究中，该因素对模型得出的结论产生了显著影响。

结论
未来针对肾功能检测的经济学评价，应从患者视角出发梳理检测与监测路径，确保分析过程中充分纳入对患者而言至关重要的问题——例如检测结果不准确的可能性。