The health-economic impact of urine albumin-to-creatinine ratio testing for chronic kidney disease in Japanese patients with type 2 diabetes

J Diabetes Investig. 2025 Jan;16(1):108-119. doi: 10.1111/jdi.14293. Epub 2024 Nov 22.

Abstract

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.

Materials and methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Albuminuria; Cost‐effectiveness analysis; Diabetes mellitus.

MeSH terms

  • Aged
  • Albuminuria* / diagnosis
  • Albuminuria* / urine
  • Biomarkers / urine
  • Cost-Benefit Analysis*
  • Creatinine* / urine
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / economics
  • Diabetes Mellitus, Type 2* / urine
  • Diabetic Nephropathies / diagnosis
  • Diabetic Nephropathies / economics
  • Diabetic Nephropathies / urine
  • East Asian People
  • Female
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Quality-Adjusted Life Years
  • Renal Insufficiency, Chronic* / diagnosis
  • Renal Insufficiency, Chronic* / economics
  • Renal Insufficiency, Chronic* / urine

Substances

  • Creatinine
  • Biomarkers