Cost-Effectiveness Analysis: CKD Screening, SGLT2 Inhibitors Can Reduce Kidney Failure Risk, Racial Disparities

Initiating chronic kidney disease (CKD) screening at age 55 yielded substantial reductions in kidney failure incidence and improvements in life expectancy across all racial and ethnic groups in the US in a recent cost-effectiveness analysis.1

Researchers evaluated the potential impact of population-wide screening for CKD combined with sodium-glucose cotransporter 2 (SGLT2) inhibitors across different racial and ethnic groups in the US. Notably, non-Hispanic Black adults experienced the most benefits in terms of reduced kidney failure incidence and increased life expectancy when compared with other racial and ethnic groups.

Earlier chronic kidney disease screening produced even greater gains and narrowed life expectancy gaps.

Image credit: Nuttapong punna

Guidelines have acknowledged the growing evidence surrounding the benefits of SGLT2 inhibitors for CKD and related conditions. Recent data have supported the integration of SGLT2 inhibitors into treatment paradigms for patients with CKD not only for their established benefits but also for their potential in addressing anemia, underscoring their multifaceted therapeutic value in nephrology care.2

The cost-effectiveness analysis, published in JAMA Network Open, utilized a decision-analytic Markov model to evaluate health outcomes, costs, and cost-effectiveness of CKD screening strategies among Hispanic adults, non-Hispanic Black adults, non-Hispanic White adults, and individuals from additional racial and ethnic groups, including Asian and multiracial individuals.1

Results showed that screening every 5 years from ages 55 to 75, coupled with SGLT2 inhibitors, was found to be cost-effective for the overall population, with an incremental cost-effectiveness ratio (ICER) of $99,100 per quality-adjusted life year (QALY) gained. Additionally, the cost-effectiveness varied across racial and ethnic groups, with the lowest ICER observed among non-Hispanic Black adults ($73,400/QALY gained).

Under standard practice, adults aged 35 years were projected to live an average of 23.9 discounted life-years (LYs) and 19.14 QALYs. However, non-Hispanic Black adults had the lowest life expectancy (22.41 LYs), while adults from other racial and ethnic groups had the highest (24.82 LYs), a 2.41-year difference. Screening every 5 years from age 55 added LYs and QALYs across all racial and ethnic groups, with the greatest gains among non-Hispanic Black adults. Earlier screening at age 45 or 35 produced even greater gains and narrowed life expectancy gaps between non-Hispanic Black and White adults by as much as 0.08 years.

Incidence of Kidney Failure by Race

Among simulated cohorts of US adults aged 35 years, non-Hispanic Black adults had the highest projected lifetime incidence of kidney failure requiring kidney replacement therapy (KRT) at 6.2% (95% uncertainty interval [UI], 2.8%-10.6%). In comparison, the projected incidence was 3.6% (95% UI, 1.1%-6.7%) for Hispanic adults, 2.3% (95% UI, 0.4%-5.2%) for non-Hispanic White adults, and 3.3% (95% UI, 1.2%-6.5%) for adults in a composite group including Asian, multiracial, and other self-reported racial and ethnic identities.

Under the current standard of care, without systematic CKD screening, the largest gap in cumulative incidence was between non-Hispanic Black and non-Hispanic White adults, at 4.0 percentage points (pp; 95% UI, −0.6 to 8.7). Implementing population-wide CKD screening every 5 years from ages 55 to 75, combined with treatment with SGLT2 inhibitors, significantly reduced the incidence of kidney failure requiring KRT across all groups.

On average, this approach reduced the incidence by 0.5 pp, resulting in an overall rate of 2.7%. The largest reductions were observed among non-Hispanic Black adults (−0.8 pp), Hispanic adults (−0.7 pp), and adults from other racial and ethnic groups (−0.6 pp), compared with a smaller reduction among non-Hispanic White adults (−0.4 pp). Initiating screening earlier at age 35 was projected to reduce kidney failure incidence by an additional 1.0 pp among non-Hispanic Black adults.

The analysis also projected the total number of CKD-related kidney failure cases across the US adult population currently aged 35 to 75. Without screening, an estimated 4.7 million people will develop kidney failure requiring KRT, with a disproportionate burden shown in Hispanic, non-Hispanic Black, and other minority adults.

Non-Hispanic Black adults, while comprising 12% of the population, were projected to account for 24% of KRT cases. Screening every 5 years starting at age 55 was projected to prevent 689,000 KRT cases nationwide. Per 10,000 people screened, more cases were averted among non-Hispanic Black adults (68), Hispanic adults (62), and adults from other racial and ethnic groups (58) compared with non-Hispanic White adults (33). Earlier screening, beginning at age 35, was estimated to prevent an additional 27,000 cases, one-third of which would be among non-Hispanic Black adults.

Cost-Effectiveness of Increased CKD Screening

Cost-effectiveness analyses indicate that population-wide screening and treatment for CKD raise health care costs but offer significant health benefits across racial and ethnic groups. For a 35-year-old, screening every 5 years from ages 55 to 75 incurs an average lifetime cost increase of $4600 to $6400 based on racial background. Overall, this strategy costs $99,100 per QALY gained, with non-Hispanic Black adults benefiting most at $73,400 per QALY, all remaining below the $150,000 per QALY threshold.

However, starting screening earlier at ages 45 or 35 tends to exceed the threshold for most groups, except for non-Hispanic Black adults, where early screening at age 35 remains cost-effective at $115,000 per QALY. Sensitivity analyses reveal that the effectiveness of SGLT2 inhibitors significantly influences cost-effectiveness. A 35% reduction in their efficacy raises costs above the threshold for all groups but non-Hispanic Black adults. Conversely, a 50% reduction in SGLT2 inhibitor prices improves cost-effectiveness, making screening every 5 years from ages 45 to 75 cost $132,900 per QALY for the overall population and $67,500 for non-Hispanic Black adults.

"Earlier initiation of screening at age 45 or 35 years yielded further benefits for all patient groups—in particular non-Hispanic Black adults—and additional reductions in CKD disparities but was not cost-effective for the overall population under base case assumptions," the authors concluded. "In determining the optimal population-wide screening strategy, policymakers should consider trade-offs between efficiency and equity."

References

1. Cusick MM, Tisdale RL, Adams AS, et al. Balancing efficiency and equity in population-wide CKD screening. JAMA Netw Open. 2025;8(4):e254740. doi:10.1001/jamanetworkopen.2025.4740

2. Grossi G. Meta-Analysis Finds SGLT2 Inhibitors boost hemoglobin, hematocrit in CKD. AJMC®. April 8, 2025. Accessed April 18, 2025. https://www.ajmc.com/view/meta-analysis-finds-sglt2-inhibitors-boost-hemoglobin-hematocrit-in-ckd