Economic evaluation of alternative indicators for screening for diabetes mellitus.
BACKGROUND
the optimal indicator for screening for diabetes mellitus without relying on fasting conditions was clarified.


METHODS
the subjects were 891 men ages 26 through 80 years (48.5 +/- 8.5). The objectives of this study were (1) to elucidate the efficacy of 1,5-anhydroglucitol (1,5-AG), glycosylated hemoglobin, and fructosamine (FRA) as screening tests for non-insulin-dependent diabetes mellitus (NIDDM) or for impaired glucose tolerance (IGT) and (2) to perform an economic evaluation for each indicator. The efficacy of each indicator was evaluated by drawing the receiver operating characteristic curves and calculating the areas under these curves (AUCs). An original model was developed for the pur pose of cost-effectiveness analysis.


RESULTS
each indicator was evaluated as a screening test for NIDDM alone and for both IGT and NIDDM. The AUCs of 1,5-AG and fasting plasma glucose were the largest in the case of the detection of NIDDM alone and the detection of both IGT and NIDDM, respectively. FRA was, however, the most cost-effective in Japan.


CONCLUSIONS
using equations, we indicated the equi librium points at which the cost-effectiveness ratios of each indicator intersected in order to generalize the results. By calculating the appropriate-actual ratios of costs for each indicator, we could ascertain the optimal indicator for each country.
Shirasaya
K
K
Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, 160, Japan.
Miyakawa
M
M
Yoshida
K
K
Takahashi
E
E
Shimada
N
N
Kondo
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003847:Deoxyglucose / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis*; D019270:Fructosamine / Q000097:blood*; D018149:Glucose Intolerance / Q000097:blood* / Q000175:diagnosis*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D017059:Models, Econometric; D012680:Sensitivity and Specificity
D003847:Deoxyglucose; D019270:Fructosamine; D006442:Glycated Hemoglobin; C006584:1,5-anhydroglucitol