Costs of Screening for Pre-diabetes Among U.S. Adults

Abstract

OBJECTIVE -We evaluated various strategies to identify individuals aged 45-74 years with pre-diabetes (either impaired glucose tolerance or impaired fasting glucose). RESEARCH DESIGN AND METHODS -We conducted a cost analysis to evaluate the effectiveness (proportion of cases identified), total costs, and efficiency (cost per case identified) of five detection strategies: an oral glucose tolerance test (OGTT), a fasting plasma glucose (FPG) test, an HbA 1c test, a capillary blood glucose (CBG) test, and a risk assessment questionnaire. For the first strategy, all individuals received an OGTT. For the last four strategies, only those with a positive screening test received an OGTT. Data were from the Third U.S. National Health and Nutrition Examination Survey, 2000 census, Medicare, and published literature. One-time screening costs were estimated from both a single-payer perspective and a societal perspective.RESULTS -The proportion of pre-diabetes and undiagnosed diabetes identified ranged from 69% to 100% (12.1-17.5 million). The cost per case identified ranged from $176 to $236 from a single-payer perspective and from $247 to $332 from a societal perspective. Testing all with OGTT was the most effective strategy, but the CBG test and risk assessment questionnaire were the most efficient. If people are substantially less willing to take an OGTT than a FPG test, then the FPG testing strategy was the most effective strategy.CONCLUSIONS -There is a tradeoff between effectiveness and efficiency in choosing a strategy. The most favorable strategy depends on if the goal of the screening program is to identify more cases or to pursue the lowest cost per case. The expected percentage of the population willing to take an OGTT is also a consideration. Diabetes Care 26:2536 -2542, 2003T ype 2 diabetes is a serious and costly disease and a growing public health problem (1,2). Despite the availability and use of a number of effective treatments to prevent diabetes complications, the disease pursues a degenerative path. Results of recent clinical trials indicate that the progression to diabetes from impaired glucose tolerance (IGT) can be delayed or prevented substantially by lifestyle modification or medications (3-5).Responding to the results of the Diabetes Prevention Program (DPP) and other prevention trials, the American Diabetes Association (ADA) has recommended that diabetes prevention efforts target people with pre-diabetes (either IGT or impaired fasting glucose [IFG]) (6). To identify people with pre-diabetes, the ADA has recommended screening during a health care office visit for men and women who are age Ն45 years, particularly those with a BMI Ն25 kg/m 2 . The purpose of this study was to examine the effectiveness, costs, and efficiency of five strategies to identify people with prediabetes based on a one-time screening of the U.S population. RESEARCH DESIGN AND METHODS Study populationOur study population included individuals age 45-74 years who visited a health care provider at least once in the past year and ...

Screening for type 2 diabetes: literature review and economic modelling

“…Zhang and colleagues 204 addressed a similar question to that of Icks and colleagues. 201 However, they assessed the efficacy, effectiveness and efficiency of various strategies for detecting both cases of prediabetes (IGT and/or IFG) and cases of undiagnosed diabetes.…”

“…The searches identified five studies for inclusion in this section of the review [201][202][203][204][205] These studies are summarised in Table 16 and discussed in detail below.…”

“…The studies reviewed in this section [201][202][203][204][205] all assessed the short-term costs and consequences of different approaches to screening for T2DM, or IGT and IFG. All considered the costs that would be incurred and the number of cases that would be identified using different tests or different cutoff points on the same test.…”

“…The screening strategies assessed by Zhang and colleagues 204 were as follows: (1) an OGTT for everyone in the study population; (2) an FPG test for everyone followed by an OGTT for those with fasting glucose levels above the cut-off used (95 mg/dl) but below the level used to diagnose impaired fasting glucose (110 mg/dl); (3) an HbA 1c test with an OGTT for those with an HbA 1c level above 5%; (4) a capillary blood glucose (CBG) test with an OGTT for those with capillary glucose above 100 mg/dl; and (5) a risk assessment questionnaire followed by an OGTT for those who scored above a certain limit. The cut-off points used for the FPG, HbA 1c and CBG tests were reportedly selected on the basis that they incurred the lowest cost per case detected out of a range of cut-off points tested, but the analysis used to inform this decision was not reported in the paper.…”

Heart Failure in Women

“…5 Previous studies have shown that women treated for chronic HF are more likely than men to have HF with preserved ejection fraction (HFPEF). 5,8 A large proportion of women who are admitted for acute decompensated HF have preserved systolic function with many comorbidities. 9 In addition, clinical outcomes among women with HF have not improved at the same rate as those seen in men.…”