Each value is shown in Table 1. Transition probabilities from (1) screened and/or examined to (4) stroke
with no treatment are adopted from Kimura et al. [22] by initial dipstick test result, age and sex. Each value is shown in Table 1. Reductions of these transition probabilities brought about by treatment of CKD are set at 69.3% based on Arima et al. [23]. The subsequent transition probabilities to (5) death are adopted from Kimura et al. [22] by age and sex for the first year, and calculated from the Stroke Register in Akita of Suzuki [25, 26] for the second year and thereafter. GSK458 purchase Each value is shown in Table 1. A transition probability from (3) heart attack and (4) stroke to (2) ESRD is adopted from an epidemiological
LY294002 study in Okinawa by Iseki et al. [27]. Transition probabilities from (1) screened and/or examined to (5) death are adopted from Vital Statistics of Japan 2008 [28] by age and sex. Each value is shown in Table 1. We take a life-long time horizon so that the Markov cycle is repeated until each age stratum reaches 100 years old. Quality of life adjustment In order to estimate outcomes, use of quality-adjusted life years (QALYs) is recommended for economic evaluation of health care [29, 30]. QALYs are calculated as the sum of adjusted life-years experienced by a patient, where the adjustment is made by multiplying time by weights linked to the changing health state of the patient. The quality-adjustment weight is a value between 1 (perfect health) and 0 (death), which is one of the health-related quality of life measurements. Regarding (1) screened and/or examined, weights are assigned according to CKD stage based on initial renal function, using values adopted from Tajima et al. [31]. Weights for (2) ESRD, (3) heart attack and (4) stroke are cited from a past economic evaluation of antihypertensive treatment in Japanese context by Saito et al. [32]. Costing From the societal Thiamine-diphosphate kinase perspective, costing should cover the opportunity cost borne by various economic entities in society. In the context of this study, costs borne by social insurers
and patients are considered, since the cost of SHC is borne by social insurers and the cost of treatment is shared by social insurers and patients in Japan’s health system. The click here amount of direct payments to health care providers by these entities is estimated as costs, while costs of sector other than health and productivity losses are left uncounted in this study. Cost items are identified along the decision tree and Markov model: screening, detailed examination, treatment of CKD, treatment of ESRD, treatment of heart attack and treatment of stroke. Each value is shown in Table 1. Costs of screening were surveyed in five prefectures by inquiring health checkup service providers’ price of adding CKD screening test to a test package that does not include renal function tests.