The compliance and cost-effectiveness of smartphone urinalysis albumin screening for people with diabetes in England

ABSTRACT

Background

People with diabetes are at increased risk of developing chronic kidney disease (CKD) and should undergo annual screening, but adherence is poor. A home urinalysis self-test has been developed to improve compliance with screening. The objective of this paper is to report on a clinical evaluation and economic analysis of home urinalysis self-testing.

Research design and methods

People with diabetes who had not undergone screening within the previous 18 months were recruited to a single-arm clinical evaluation to assess the uptake and compliance of home urinalysis self-testing. An economic evaluation assessed the likely cost-consequences of the use of home urinalysis self-testing over a lifetime time horizon.

Results

A total of 2,196 people with diabetes were contacted as part of the clinical evaluation. Of these, 695 people agreed to be sent a home urinalysis self-testing kit and 499 people completed and returned the test.

Cost savings of £2,008 per person were estimated over a lifetime due to increased CKD diagnosis and reduced progression to end stage renal disease.

Conclusions

Home urinalysis self-testing of ACR in people with diabetes is estimated to be a cost-effective use of NHS resources in England in people who would otherwise not comply with standard care.

KEYWORDS:

• Diabetes
• kidney disease
• cost-consequence analysis
• economic evaluation
• chronic kidney disease

Article Highlights

• A home urinalysis self-test has been developed to improve compliance with screening for chronic kidney disease in people with diabetes

• Damage to kidneys caused by diabetes is a significant risk factor for end stage renal disease and people with diabetes are nearly one and half times more likely to need renal replacement therapy.

• An evaluation of 695 people with diabetes at participating Modality GP surgeries demonstrated compliance rates of 72% in people that had previously been non-compliant with screening.

• The key barrier to home testing appears to be agreement to its use initially, with only 32% of people with diabetes in the evaluation agreeing to be sent a home urinalysis self-testing kit, with the main reason being lack of smartphone ownership.

• Usability was assessed and out of those who responded, 92% said they found the test easy or very easy to use and the majority preferred home testing to testing at a GP surgery

• A cost-effectiveness model based on the Modality evaluation was developed which showed home urinalysis testing has the potential to save approximately £2,000 per patient over their lifetime

Author contribution statement

The cost model was developed by JS and MG. AH and DL designed and conducted the clinical evaluation. JS and MG drafted this paper with review from both other authors. AH and DL are accountable for the clinical evaluation, and JS and MG are accountable for all other aspects.

Declaration of interest

J Shore and M Green are employees of York Health Economics Consortium who were paid consultancy fees for the development of this paper from Health.io.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

The supplementary data for this article can be accessed here.

Additional information

Funding

York Health Economics Consortium was provided with financial support (via consultancy fees) for this manuscript by Healthy.io. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.