Screening to detect type 2 diabetes can be cost- effective

January 01, 0001

Screening to detect type 2 diabetes can be cost- effective

No clinical trials have previously assessed the effects or cost- effectiveness of sequential screening strategies to detect new cases of type 2 diabetes. The researchers from the USA, Denmark, UK and Finland used a mathematical model to estimate the cost-effectiveness of several screening strategies. They used person-specific data from a representative sample of the US population to create a simulated population of 325,000 people aged 30 years without diabetes.

They found that compared with no screening, all simulated screening strategies reduced the incidence of myocardial infarction (3—9 events prevented per 1000 people screened) and diabetes-related microvascular complications (3—9 events prevented per 1000 people), and increased the number of quality-adjusted life-years (QALYs) (93—194 undiscounted QALYs) added over 50 years. Most strategies prevented a significant number of simulated deaths (2—5 events per 1000 people). There was little or no effect of screening on incidence of stroke (0—1 event prevented per 1000 people). Five screening strategies had costs per QALY of about US$10,500 or less, whereas costs were much higher for screening started at 45 years of age and repeated every year ($15,509), screening started at 60 years of age and repeated every 3 years ($25,738), or a maximum screening strategy (screening started at 30 years of age and repeated every 6 months; $40,778). Several strategies differed substantially in the number of QALYs gained. Costs per QALY were sensitive to the disutility assigned to the state of having diabetes diagnosed with or without symptoms.

The researchers concluded: "In the US population, screening for type 2 diabetes is cost effective when started between the ages of 30 years and 45 years, with screening repeated every 3—5 years."

This will become more important as the incidence and prevalence of type 2 diabetes increases.

For the full abstract, click here.

The Lancet published online 30 March 2010
© Elsevier Ltd 2010
Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis. Richard Kahn, Peter Alperin, David Eddy et al. Correspondence to Richard Kahn:

Category: T. Endocrine/Metabolic/Nutritional, HSR. Health Services Research. Keywords: generic, substitution, medications, Australia, assessment of claims records, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 23 April 2010

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