Screening for type 2 diabetes mellitus: a cost-effectiveness analysis.
BACKGROUND
No randomized, controlled trial of screening for diabetes has been conducted. In the absence of direct evidence, cost-effectiveness models may provide guidance about preferred screening strategies.


OBJECTIVE
To estimate the incremental cost-effectiveness of 2 diabetes screening strategies: screening targeted to people with hypertension and universal screening.


METHODS
Markov model.


METHODS
United Kingdom Prospective Diabetes Study, Hypertension Optimal Treatment trial, and recent cost data.


METHODS
General primary care population in the United States.


METHODS
Lifetime.


CONCLUSIONS
Health care system.


METHODS
Diabetes screening targeted to people with hypertension and universal screening.


METHODS
Cost per quality-adjusted life-year (QALY) gained. Costs (in 1997 U.S. dollars) and QALYs discounted at a 3% annual rate.


RESULTS
At all ages, incremental cost-effectiveness ratios were more favorable for screening targeted to people with hypertension than for universal screening. For example, at age 55 years, the cost per QALY for targeted screening compared with no screening was 34,375 dollars, whereas the cost per QALY for universal screening compared with targeted screening was 360,966 dollars. Screening was more cost-effective for ages 55 to 75 years than for younger ages.


RESULTS
In single-way and probabilistic sensitivity analyses, findings were robust to therapy costs, screening costs, screening lead time, reduced effectiveness of intensive antihypertensive therapy, and increased relative risk reduction for stroke attributable to intensive hypertension control.


CONCLUSIONS
We did not consider screening targeted to persons with dyslipidemia, and we used studies of people whose diabetes was detected clinically to estimate screening benefits.


CONCLUSIONS
Diabetes screening targeted to people with hypertension is more cost-effective than universal screening. The most cost-effective strategy is targeted screening at age 55 to 75 years.
Hoerger
Thomas J
TJ
RTI International, Research Triangle Park, North Carolina 27709, USA. tjh@rti.org
Harris
Russell
R
Hicks
Katherine A
KA
Donahue
Katrina
K
Sorensen
Stephen
S
Engelgau
Michael
M
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis*; D003925:Diabetic Angiopathies / Q000150:complications; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity