Economic Evaluation of Point-of-Care Creatinine Testing Compared with Conventional Laboratory-Based Testing for Early Detection of Chronic Kidney Disease in India: A Decision- Analytic Model

Abstract

Background: Chronic kidney disease (CKD) affects an estimated 128 million adults in India, yet early detection remains
hampered by reliance on centralised laboratory infrastructure with turnaround times of 24–48 hours. Point-of-care (POC)
creatinine/estimated glomerular filtration rate (eGFR) testing offers a rapid, decentralised alternative. However, robust economic
evidence comparing POC testing with conventional laboratory methods in the Indian context is lacking.
Methods: A decision-analytic model (decision tree) was constructed to compare the cost-effectiveness of POC creatinine/eGFR
testing (NOVA MAX system) with conventional laboratory-based testing from a societal perspective over a one-month time
horizon, capturing the full diagnostic episode and its immediate clinical consequences. The model incorporated direct medical
costs (test, consumables, staff, equipment, confirmatory investigations) and indirect costs (patient travel and productivity loss).
Clinical accuracy parameters sensitivity (0.43–0.44) and specificity (0.97–0.98) were derived from a systematic review and
meta-analysis. Health outcomes (QALYs) were derived by applying published EQ-5D utility weights to each diagnostic outcome
category (TP, TN, FP, FN) over the model time horizon. India’s willingness-to-pay (WTP) threshold of ₹2,31,784 per QALY
was applied. One-way (OWSA) and probabilistic sensitivity analyses (PSA) with Monte Carlo simulation were performed.
Results: In the base-case analysis, mean costs per patient were ₹317 (POCT) and ₹419 (laboratory testing), yielding an
incremental cost of −₹102 in favour of POCT. Incremental QALYs were −0.135, placing the ICER at ₹1,276 in the southwest
quadrant of the cost-effectiveness plane, indicating POCT is cost-saving. The cost-effectiveness acceptability curve
demonstrated that POCT had a 90–92% probability of being cost-effective across all WTP thresholds examined. Tornado plot
analyses identified POCT true-positive probability as the dominant driver of model uncertainty.
Conclusion: POC creatinine testing is a cost-saving and operationally superior strategy compared with conventional laboratory
testing for early CKD detection in India. Despite marginally lower QALYs attributable to moderate sensitivity, the substantial
cost advantages and suitability for decentralised settings make POCT a pragmatic, scalable complement to laboratory assays,
particularly aligned with India’s National Programme for Prevention and Control of Non-communicable Diseases (NPCDCS).