[A cost analysis of diagnostic screening for the differentiation of type-1 and type-2 diabetics aged 30 to 45. A health economics modelling calculation].
OBJECTIVE
Because of its chronic course and increasing incidence diabetes mellitus is assuming increasing importance not only for medical reasons but also on health policy. Early recognition of carriers of autoantibodies among type 2 diabetics (noninsulin-dependent; NIDDM) and the resulting optimization of blood glucose could lead to a reduction of secondary diseases. A health-economic model for calculating costs was used to test the socioeconomic significance of a screening programme for identifying carriers of antibodies against glutamic acid decarboxylase among NIDDM diabetics.


METHODS
Health-economic analysis was based on the incidence of positive autoantibody tests among diabetics aged between 30 and 45 years. Results for a cohort of diabetics who had been screened were compared with those obtained in a control group without screening. A time-span of 20 years was chosen because of the late manifestations of diseases secondary to DM. The model calculations used a cost analysis. Data were based on interventional clinical and epidemiological studies. Cost of treatment of secondary diseases was confined to a one-year period. In the first instance the direct medical costs and additionally the indirect economic costs, generated by patients' loss of production and disability to work were calculated. One-dimensional sensitivity analysis was used to check the assumptions underlying the model.


RESULTS
Per patient in the model, total costs of the screening programme over a period of 20 years were calculated at DM 31,278, of which DM 7,799 were direct and DM 23,479 indirect costs. The calculated costs for the control subjects (no screening) were DM 35,290, of which DM 10,984 were direct and DM 24,306 indirect costs.


CONCLUSIONS
Extrapolating to the entire population, with an investment by the statutory health insurance of ca. DM 22.8 million, employing a full screening programme would lead to a saving of DM 2.6 billion.
Kilburg
A
A
Institut für Empirische Gesundheitsökonomie, Burscheid. instfeg@t-online.de
Bruchhausen
Y
Y
Thomas
J
J
Rychlik
R
R
D000328:Adult; D001323:Autoantibodies / Q000097:blood; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003663:Decision Trees; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis* / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000191:economics*; D003937:Diagnosis, Differential; D004180:Direct Service Costs / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D012680:Sensitivity and Specificity
D001323:Autoantibodies; D005968:Glutamate Decarboxylase