A cost analysis of community screening for diabetes in the central Wisconsin Medicare population (results from the MetaStar pilot project in Wausau).
BACKGROUND
Type 2 diabetes mellitus is often undiagnosed and untreated.


OBJECTIVE
To estimate the costs and possible savings of screening for Type 2 diabetes mellitus in the Wisconsin Medicare population from a population health perspective.


METHODS
The costs and benefits of community screening were analyzed using various primary and secondary data sources. Data on the community screening were obtained by MetaStar, collaborators at the screening site, and published material. Results from a Monte Carlo simulation model, developed by the CDC Diabetes Cost-Effectiveness Study Group, and recent developments in diabetes research were used to estimate the incidence levels of major complications for Type 2 diabetes.


METHODS
Medicare beneficiaries in central Wisconsin residing in the Wausau Hospital Service Area, which is composed of 14 zip codes.


RESULTS
Of 826 Medicare patients screened, 32 were diagnosed as having diabetes. If we use the same assumptions offered by the CDC Study Group, we find that the excess lifetime costs from screening and early treatment ($4850) exceed costs saved from preventing complications ($378), costing an average of $4471 per diabetic. However, if we alter assumptions on cardiovascular disease reduction risk and routine care costs, we find that screening could save an average of $619 per diabetic detected.


CONCLUSIONS
The costs of community screening, using the CDC Study Group's assumptions, are greater than the costs of diabetes without screening in this population. However, recent evidence on cardiovascular disease risk and routine care costs could alter the results, leading to lower costs and greater benefits in the future. More research is necessary, particularly in the area of quality of life measures, to more accurately reflect the benefits of screening.
University of Wisconsin Medical School in Madison, USA. donlee@students.wisc.edu
D S
DS
Lee
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Remington
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Madagame
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Blustein
D000368:Aged; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics* / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D006278:Medicare / Q000706:statistics & numerical data; D017059:Models, Econometric; D009010:Monte Carlo Method; D014481:United States; D014922:Wisconsin