Cost-effectiveness of Screening Strategies for Identifying Pediatric Diabetes Mellitus and Dysglycemia

Abstract

Objective To conduct a cost-effectiveness analysis of screening strategies for identifying children with type 2 diabetes mellitus and dysglycemia (prediabetes/diabetes). Design Cost simulation study. Setting A one-time US screening program. Study Participants A total of 2.5 million children aged 10 to 17 years. Intervention Screening strategies for identifying diabetes and dysglycemia. Main Outcome Measures Effectiveness (proportion of cases identified), total costs (direct and indirect), and efficiency (cost per case identified) of each screening strategy based on test performance data from a pediatric cohort and cost data from Medicare and the US Bureau of Labor Statistics. Results In the base-case model, 500 and 400 000 US adolescents had diabetes and dysglycemia, respectively. For diabetes, the cost per case was extremely high ($312 000–$831 000 per case identified) because of the low prevalence of disease. For dysglycemia, the cost per case was in a more reasonable range. For dysglycemia, preferred strategies were the 2-hour oral glucose tolerance test (100% effectiveness; $390 per case), 1-hour glucose challenge test (63% effectiveness; $571), random glucose test (55% effectiveness; $498), or a hemoglobin A1c threshold of 5.5% (45% effectiveness; $763). Hemoglobin A1c thresholds of 5.7% and 6.5% were the least effective and least efficient (ranges, 7%–32% and $938– $3370) of all strategies evaluated. Sensitivity analyses for diabetes revealed that disease prevalence was a major driver of cost-effectiveness. Sensitivity analyses for dysglycemia did not lead to appreciable changes in overall rankings among tests. Conclusions For diabetes, the cost per case is extremely high because of the low prevalence of the disease in the pediatric population. Screening for diabetes could become more cost-effective if dysglycemia is explicitly considered as a screening outcome.

2. Classification and Diagnosis of Diabetes

“…The ADA acknowledges the limited data supporting A1C for diagnosing type 2 diabetes in children and adolescents. Although A1C is not recommended for diagnosis of diabetes in children with cystic fibrosis or symptoms suggestive of acute onset of type 1 diabetes and only A1C assays without interference are appropriate for children with hemoglobinopathies, the ADA continues to recommend A1C for diagnosis of type 2 diabetes in this cohort (35,36). The modified recommendations of the ADA consensus report "Type 2 Diabetes in Children and Adolescents" are summarized in Table 2.4.…”

Global trends in the incidence and prevalence of type 2 diabetes in children and adolescents: a systematic review and evaluation of methodological approaches

“…As far as we know the different methods have not been compared with respect to cost-effectiveness. Recently Wu et al conducted a costeffectiveness analysis of screening strategies for identifying type 2 diabetes and dysglycaemia (prediabetes) in children and adolescents (aged 10-17 years) [51]. Although they found that the cost of screening per case was high for diabetes, they mentioned that screening for diabetes in youth could be more cost-effective if dysglycaemia was explicitly considered as a screening outcome.…”

2. Classification and Diagnosis of Diabetes

“…The ADA acknowledges the limited data supporting A1C for diagnosing type 2 diabetes in children and adolescents. Although A1C is not recommended for diagnosis of diabetes in children with cystic fibrosis or symptoms suggestive of acute onset of type 1 diabetes and only A1C assays without interference are appropriate for children with hemoglobinopathies, the ADA continues to recommend A1C for diagnosis of type 2 diabetes in this cohort (44,45). The modified recommendations of the ADA consensus report "Type 2 Diabetes in Children and Adolescents" are summarized in Table 2.5 (46).…”