title: A comparison of cost per case detected of screening strategies for Type 2 diabetes and impaired glucose regulation: modelling study.
abstract: BACKGROUND
  To determine a cost per case detected for different screening strategies for both Type 2 diabetes alone and in combination with impaired glucose regulation.
  
  
  METHODS
  Bayesian framework modelling study using data from the ADDITION-Leicester screening study in UK multi-ethnic primary care setting. There were 5794 people aged 40-75 years (77.4% white European; 22.6% south Asian) without previously known diabetes. We compared 212 screening strategies including blood tests, a computer practice data score and a risk score, as part of a multi-stage process that all used an oral glucose tolerance test as the diagnostic test. Simulation models were created using sensitivity estimates for the expected cost per case.
  
  
  RESULTS
  The estimated costs per case identified for the 18 most sensitive strategies varied from £457 to £1639 (€526-1886, for £1=€1.15) for diabetes and £148-913 (€170-1050) for both diabetes and impaired glucose regulation. The lowest costing diabetes strategies ranged from £457 to £523 (€526-601) involving a two-stage screening strategy, a non-invasive risk stratifying tool followed by a blood test, producing sensitivities ranging from 67.1 to 82.4%.
  
  
  CONCLUSIONS
  Screening a population using a non-invasive risk stratification tool followed by a screening blood test is the most cost-effective method of screening for diabetes and abnormal glucose tolerance.
authors.affiliation: Department of Health Sciences, University of Leicester, UK. kk22@le.ac.uk
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.forename: Clare L
authors.initials: CL
authors.lastname: Gillies
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Taub
authors.forename: Samiul A
authors.initials: SA
authors.lastname: Mostafa
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Hiles
authors.forename: Keith R
authors.initials: KR
authors.lastname: Abrams
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000191:economics; D003940:Diagnostic Techniques, Endocrine / Q000191:economics; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis* / Q000191:economics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D008954:Models, Biological; D018803:Models, Economic; D012680:Sensitivity and Specificity; D006113:United Kingdom