4 This review was not limited to people with type 2 diabetes. Based on review of clinical trials and estimates of the performance characteristics of tests for proteinuria, it was estimated that screening of 20 000 Australians (>50 years) would lead to subsequent treatment of 100 prescribed with ACEi and prevention of 1.3 cases of ESKD over 2–3 years. A cost benefit evaluation indicated a net cost saving for the health care system assuming a one-off dipstick screening program in men and women over 55 based on assumed prevention of 205 cases of ESKD, 100% compliance with screening and best estimates of unit costs for screening and treatment. However,

the cost-effectiveness was quite sensitive to screening

costs with a reversal point noted occurring at $2 per person compared with a base assumption of $0.50. find more Overall savings on the base assumptions were estimated at $A70 000 (2–3 years treatment costs for ESKD). Given the sensitivity of the estimates to key areas of uncertainty with respect to ESKD risk factors in the general population including, performance of screening tests and the benefits of ACEi treatment in screen-detected low risk-subjects, it remains unclear whether population wide screening for kidney disease would do ‘more harm than good’. Presumably these uncertainties would be lower in the this website higher risk type 2 diabetes sub group favouring adoption of screening and treatment in this setting. Cass et al.,3 Craig et al.4 and Palmer et al.1 determined, that given microalbuminuria does not directly cause morbidity or mortality, the effectiveness of treating microalbuminuria can be assessed by comparing the cost of treatment to the savings resulting from the presumed

prevention of ESKD. However, it should be emphasized that no study has followed the effects of ACEi or other intervention in normotensive, microalbuminuric people with type 2 diabetes until the development of ESKD. Nevertheless, such analysis can aid in determining which of several approaches provides the most cost-effective treatment of microalbuminuria. It should be noted that treatment of microalbuminuria is only one of several prophylactic MRIP programs that may benefit people with diabetes, and cost-benefit analysis provides a useful tool in the efficient allocation of limited health resources. The alternatives to screening for and treating diabetic microalbuminuria with ACEi or ARBs are to wait until elevated BP (BP > 130/85) or gross proteinuria develops before instigating therapy, or to treat all people with type 2 diabetes with ACEi or ARBs regardless of their urinary protein excretion. Palmer et al. considered the costs and benefits for screening for albuminuria and subsequent treatment with an ARB and discussed above.1 Golan et al.