title: Cost-effectiveness of screening for pre-diabetes among overweight and obese U.S. adults.
abstract: 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.
authors: 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
authors: Thomas J
authors: TJ
authors: Hoerger
authors: Katherine A
authors: KA
authors: Hicks
authors: Stephen W
authors: SW
authors: Sorensen
authors: William H
authors: WH
authors: Herman
authors: Robert E
authors: RE
authors: Ratner
authors: Ronald T
authors: RT
authors: Ackermann
authors: Ping
authors: P
authors: Zhang
authors: Michael M
authors: MM
authors: Engelgau
mesh_terms: 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