Cost-effectiveness of screening for pre-diabetes among overweight and obese U.S. adults.
OBJECTIVE
To estimate the cost-effectiveness of screening overweight and obese individuals for pre-diabetes and then modifying their lifestyle based on the Diabetes Prevention Program (DPP).


METHODS
A Markov simulation model was used to estimate disease progression, costs, and quality of life. Cost-effectiveness was evaluated from a health care system perspective. We considered two screening/treatment strategies for pre-diabetes. Strategy 1 included screening overweight subjects and giving them the lifestyle intervention included in the DPP if they were diagnosed with both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Strategy 2 included screening followed by lifestyle intervention for subjects diagnosed with either IGT or IFG or both. Each strategy was compared with a program of no screening.


RESULTS
Screening for pre-diabetes and treating those identified as having both IGT and IFG with the DPP lifestyle intervention had a cost-effectiveness ratio of $8,181 per quality-adjusted life-year (QALY) relative to no screening. If treatment was also provided to subjects with only IGT or only IFG (strategy 2), the cost-effectiveness ratio increased to $9,511 per QALY. Changes in screening-related parameters had small effects on the cost-effectiveness ratios; the results were more sensitive to changes in intervention-related parameters.


CONCLUSIONS
Screening for pre-diabetes in the overweight and obese U.S. population followed by the DPP lifestyle intervention has a relatively attractive cost-effectiveness ratio.
Hoerger
Thomas J
TJ
Center of Excellence in Health Promotion Economics, RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709, USA. tjh@rti.org
Hicks
Katherine A
KA
Sorensen
Stephen W
SW
Herman
William H
WH
Ratner
Robert E
RE
Ackermann
Ronald T
RT
Zhang
Ping
P
Engelgau
Michael M
MM
D000328:Adult; D015992:Body Mass Index; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005951:Glucose Tolerance Test; D006801:Humans; D008019:Life Style; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D009765:Obesity / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D050177:Overweight; D011236:Prediabetic State / Q000191:economics / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology