Screening adults for pre-diabetes and diabetes may be cost-saving.
OBJECTIVE
The economic costs of hyperglycemia are substantial. Early detection would allow management to prevent or delay development of diabetes and diabetes-related complications. We investigated the economic justification for screening for pre-diabetes/diabetes.


METHODS
We projected health system and societal costs over 3 years for 1,259 adults, comparing costs associated with five opportunistic screening tests. All subjects had measurements taken of random plasma and capillary glucose (RPG and RCG), A1C, and plasma and capillary glucose 1 h after a 50 g oral glucose challenge test without prior fasting (GCT-pl and GCT-cap), and a subsequent diagnostic 75 g oral glucose tolerance test (OGTT).


RESULTS
Assuming 70% specificity screening cutoffs, Medicare costs for testing, retail costs for generic metformin, and costs for false negatives as 10% of reported costs associated with pre-diabetes/diabetes, health system costs over 3 years for the different screening tests would be GCT-pl $180,635; GCT-cap $182,980; RPG $182,780; RCG $186,090; and A1C $192,261; all lower than costs for no screening, which would be $205,966. Under varying assumptions, projected health system costs for screening and treatment with metformin or lifestyle modification would be less than costs for no screening as long as disease prevalence is at least 70% of that of our population and false-negative costs are at least 10% of disease costs. Societal costs would equal or exceed costs of no screening depending on treatment type.


CONCLUSIONS
Screening appears to be cost-saving compared to no screening from a health system perspective, and potentially cost-neutral from a societal perspective. These data suggest that strong consideration should be given to screening-with preventive management-and that use of GCTs may be cost-effective.
Chatterjee
Ranee
R
Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. rchatte2@jhu.edu.
Narayan
K M Venkat
KM
Lipscomb
Joseph
J
Phillips
Lawrence S
LS
D017848:Blood-Borne Pathogens; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D018450:Disease Progression; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000191:economics; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000592:standards; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D011236:Prediabetic State / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000191:economics