Asahi Koichi, Konta Tsuneo, Tamura Kouichi, Tanaka Fumitaka, Fukui Akira, Nakamura Yusuke, Hirose Junichi, Ohara Kenichi, Shijoh Yoko, Carter Matthew, Meredith Kimberley, Harris James, Åkerborg Örjan, Kashihara Naoki, Yokoo Takashi
Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
Department of Public Health and Hygiene, Yamagata University Graduate School of Medicine, Yamagata, Yamagata, Japan.
J Diabetes Investig. 2025 Jan;16(1):108-119. doi: 10.1111/jdi.14293. Epub 2024 Nov 22.
AIMS/INTRODUCTION: This analysis seeks to evaluate the cost-effectiveness of urine albumin-to-creatinine ratio testing compared with urine protein-creatinine ratio testing and no urine testing for the identification of kidney damage in individuals with type 2 diabetes who have, or are at risk of, chronic kidney disease in Japan.
A health-economic model estimated the clinical and economic consequences of different tests to evaluate kidney damage in line with Japanese guidelines, taking a Japanese healthcare perspective. Differences in the diagnostic performance of tests were considered by the integration of real-world Japanese data. Outcomes were considered over a lifetime horizon, and included costs, prevented dialyses, life years gained, quality-adjusted life years, and incremental cost-effectiveness ratios.
Repeated urine albumin-to-creatinine ratio testing was found to be cost-effective compared with both urine protein-creatinine ratio testing and no urine testing, yielding incremental cost-effectiveness ratios of ¥2,652,693 and ¥2,460,453, respectively.
Repeated urine albumin-to-creatinine ratio testing is cost-effective compared with urine protein-creatinine ratio testing and no urine testing in Japanese individuals with type 2 diabetes, supporting existing clinical evidence that albumin-to-creatinine ratio testing should be used more widely, particularly compared with other urine tests such as urine protein-creatinine ratio testing.
目的/引言：本分析旨在评估在日本患有或有慢性肾病风险的2型糖尿病患者中，与尿蛋白-肌酐比值检测及不进行尿液检测相比，尿白蛋白-肌酐比值检测在识别肾脏损伤方面的成本效益。
一个健康经济模型根据日本指南，从日本医疗保健的角度估计了不同检测评估肾脏损伤的临床和经济后果。通过整合日本实际数据考虑检测诊断性能的差异。结果在终身范围内进行考量，包括成本、预防的透析次数、获得的生命年数、质量调整生命年数以及增量成本效益比。
与尿蛋白-肌酐比值检测及不进行尿液检测相比，重复进行尿白蛋白-肌酐比值检测被发现具有成本效益，增量成本效益比分别为2,652,693日元和2,460,453日元。
在日本2型糖尿病患者中，与尿蛋白-肌酐比值检测及不进行尿液检测相比，重复进行尿白蛋白-肌酐比值检测具有成本效益，支持现有的临床证据，即白蛋白-肌酐比值检测应更广泛地使用，特别是与其他尿液检测如尿蛋白-肌酐比值检测相比。
