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 ...