RATIONALE & OBJECTIVE On account of the high prevalence of cardiovascular disease in patients with kidney failure, clinical practice guidelines recommend regular screening for asymptomatic coronary artery disease (CAD) in patients on the kidney transplant waitlist. To date, the cost-effectiveness of such screening has not been evaluated. A Canadian-Australasian randomized controlled trial of screening kidney transplant candidates for CAD (CARSK) is currently is being conducted to answer this question. We conducted a cost-utility analysis to determine, before completion of the trial, the cost-effectiveness of no further screening versus regular screening for asymptomatic CAD and to evaluate potential influential variables that may affect results of the economic evaluation. STUDY DESIGN A modeled cost-utility analysis. SETTING & POPULATION A theoretical cohort of adult Australian and New Zealand kidney transplant candidates on the waitlist. INTERVENTION No further screening for asymptomatic CAD versus regular protocolized screening (annual or second yearly) for CAD after kidney transplant waitlisting. OUTCOMES Incremental cost-effectiveness ratio, reported as cost per quality-adjusted life-year (QALY). MODEL, PERSPECTIVES, & TIMEFRAME Markov microsimulation model, health system perspective and over a lifetime horizon. RESULTS In the base case, the incremental cost-effectiveness ratio of no further screening was $11,122 per QALY gained when compared with regular screening. No further screening increased survival by 0.49 life-year or 0.35 QALY. One-way sensitivity analyses identified the costs of transplantation in the first year and CAD prevalence as the most influential variables. Probabilistic sensitivity analyses showed that 94% of the simulations were cost-effective below a willingness-to-pay threshold of $50,000 per QALY gained. LIMITATIONS Rates of cardiovascular events in waitlisted candidates and transplant recipients are limited in the contemporary era. The results may not be generalizable to populations outside Australia and New Zealand. CONCLUSIONS No further screening for CAD after waitlisting is likely to be cost-effective and may improve survival. Precision around CAD prevalence estimates and health care resource use will reduce existing uncertainty.

中文翻译：

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在等待名单中的肾脏移植候选人中筛查无症状冠状动脉疾病：成本-效用分析。

理由与目的由于肾衰竭患者中心血管疾病的患病率很高，因此临床实践指南建议对接受肾移植候补的患者进行无症状性冠状动脉疾病（CAD）的常规筛查。迄今为止，尚未评估这种筛选的成本效益。目前正在开展一项加拿大-澳大利亚人随机对照试验，以筛查CAD的肾脏移植候选者（CARSK）以回答该问题。我们进行了成本-效用分析，以确定在试验完成之前不进行进一步筛查与常规筛查无症状CAD的成本效果，并评估可能影响经济评估结果的潜在影响变量。研究设计建模的成本效用分析。环境 ＆人口候补名单上有澳大利亚和新西兰成年肾移植候选人的理论队列。干预在肾脏移植候补名单之后，与常规的常规筛查（每年一次或每年第二次）相比，无进一步的无症状CAD筛查。成果成本效益比增量，报告为每质量调整生命年（QALY）的成本。模型，透视图和时间范围马尔可夫微观仿真模型，卫生系统的观点以及整个生命周期。结果在基本情况下，与常规筛查相比，无需进一步筛查的每QALY所获得的增量成本效益比为11,122美元。没有进一步的筛查可将生存期提高0.49生命年或0.35 QALY。单向敏感性分析确定了第一年的移植费用和CAD患病率是最有影响力的变量。概率敏感性分析表明，94％的模拟在每次获得QALY 50,000美元的支付意愿阈值以下时具有成本效益。局限性在当今时代，候补候选人和移植受者的心血管事件发生率受到限制。结果可能无法推广到澳大利亚和新西兰以外的地区。结论在等待名单后没有进一步筛查CAD可能是划算的，并且可以提高生存率。CAD患病率估计值和医疗保健资源使用的精确度将减少​​现有的不确定性。概率敏感性分析表明，94％的模拟在每获得一个QALY 50,000美元的支付意愿阈值以下时具有成本效益。局限性在当今时代，候补候选人和移植受者的心血管事件发生率受到限制。结果可能无法推广到澳大利亚和新西兰以外的地区。结论在等待名单后没有进一步筛查CAD可能是划算的，并且可以提高生存率。CAD患病率估算和医疗资源使用的精确度将减少​​现有的不确定性。概率敏感性分析表明，94％的模拟在每获得一个QALY 50,000美元的支付意愿阈值以下时具有成本效益。局限性在当今时代，候补候选人和移植受者的心血管事件发生率受到限制。结果可能无法推广到澳大利亚和新西兰以外的地区。结论在等待名单后没有进一步筛查CAD可能是划算的，并且可以提高生存率。CAD患病率估计值和医疗保健资源使用的精确度将减少​​现有的不确定性。结果可能无法推广到澳大利亚和新西兰以外的地区。结论在等待名单后没有进一步筛查CAD可能是划算的，并且可以提高生存率。CAD患病率估计值和医疗保健资源使用的精确度将减少​​现有的不确定性。结果可能无法推广到澳大利亚和新西兰以外的地区。结论在等待名单后没有进一步筛查CAD可能是划算的，并且可以提高生存率。CAD患病率估计值和医疗保健资源使用的精确度将减少​​现有的不确定性。