Decreasing the effect by 50% increases ICER to ¥16,280,537/QALY (US $180,895/QALY). The effectiveness of CKD treatment to prevent stroke is also found to be the 10th largest change of ICER, but its range is limited. The cost of treatment for stage 5 CKD is found to be the
second most sensitive. Increasing the cost by 50% increases ICER to ¥14,404,335/QALY (US $160,048/QALY). The cost of ESRD treatment is found to be the fifth largest change, and the change is in the opposite direction; decreasing this increases ICER. Another cost item depicted is the cost of treatment for stage 3 CKD, which is SNS-032 found to be the sixth largest change. The discount rate is found to be the third most sensitive. Discounting at a rate of 5% makes ICER ¥11,373,185/QALY (US $126,369/QALY). Since policy 1 can screen CKD patients without
proteinuria by use of serum Cr assay, selleck chemicals the prognosis of non-proteinuric stage 5 CKD without treatment is found sensitive as the fourth and the seventh largest change. The eighth largest change depicted relates to the prevalence of CKD in participating population, i.e. stage 2 CKD without proteinuria. The ninth largest change is utility weight for ESRD. Taking the threshold to judge cost-effectiveness, one-way sensitivity analyses alter the interpretation of the results for only three variables: reductions of transition probabilities from (1) screened and/or examined to (2) ESRD with the treatment of CKD; cost of treatment Obeticholic Acid cell line for stage 5 CKD; and transition probability from (1) screened and/or examined to (2) ESRD with no treatment by initial renal function for stage 5 CKD without proteinuria. Discussion We conduct a cost-effectiveness analysis of CKD screening test in SHC. Facing the scheduled revision of mandatory test items, we appraise two possible policy options compared with the status quo that 40% of insurers implement dipstick test to check proteinuria only and 60% implement dipstick test and serum Cr assay. Policy 1 is to Lonafarnib order mandate serum Cr assay in addition to
the current dipstick test, so that 100% of insurers implement both dipstick test and serum Cr assay. Policy 2 is to mandate serum Cr assay and abandon dipstick test, so that 100% of insurers would stop providing dipstick test and switch to serum Cr assay. Our base-case analysis suggests that both policy options cost more and gain more. Estimated ICERs are ¥9,325,663/QALY (US $103,618/QALY) for policy 1 and ¥9,001,414/QALY (US $100,016/QALY) for policy 2. To interpret these ICERs, there is no established value of social willingness to pay for one QALY gain in public health programmes such as mass screening in Japan, although some suggest ¥5 million/QALY (US $56 thousand/QALY) for an innovative medical intervention . We follow WHO recommendation in this study, which is three times GDP per capita . Its value is ¥11.5 million/QALY (US $128 thousand/QALY) gain in 2009 in Japan.