title: Screening for T1D risk to reduce DKA is not economically viable.
abstract: BACKGROUND
  Children at high risk for developing type 1 diabetes (T1D) can be identified on the basis of human leukocyte antigen (HLA) genotype and the subsequent development of islet cell autoantibodies. Several studies have documented reduced incidence of diabetic ketoacidosis (DKA) in new-onset T1D when high-risk children are identified at an early age. Many have questioned whether general population screening for T1D risk should be standard of practice. We sought to perform a purely economic, cost-benefit analysis to determine if a screening program to reduce the incidence of DKA at diagnosis in children less than 5 yr is cost effective.
  
  
  METHODS
  We compared the cost of population screening with the benefit of preventing DKA. The cost of screening included one-time HLA typing on the entire population followed by islet cell autoantibody testing in high-risk children every 6 months until age 5 yr. The potential benefits of screening included reductions in parental lost income, medical expenses, morbidity, and mortality.
  
  
  RESULTS
  Screening for T1D risk for the sole purpose of reducing the cost of DKA at onset of T1D was not economically viable unless HLA testing and autoantibody testing could be performed for less than $1 and $0.03, respectively.
  
  
  CONCLUSIONS
  Current screening costs far outweigh the economic benefits of preventing new-onset DKA in children under 5 yr of age.
authors.affiliation: Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32608, USA.
authors.forename: Colette
authors.initials: C
authors.lastname: Meehan
authors.affiliation: Abt Associates, 4550 Montgomery Ave., Suite 800 North, Bethesda, MD, 20814, USA.
authors.forename: Betty
authors.initials: B
authors.lastname: Fout
authors.affiliation: Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32608, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Ashcraft
authors.affiliation: Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32608, USA.
authors.forename: Desmond A
authors.initials: DA
authors.lastname: Schatz
authors.affiliation: Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32608, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Haller
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis*; D016883:Diabetic Ketoacidosis / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D008403:Mass Screening / Q000191:economics*
keywords: DKA; T1D; screening