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The CDC Diabetes Cost-Effectiveness Study Group. The Cost-effectiveness of Screening for Type 2 Diabetes. JAMA. 1998;280(20):1757–1763. doi:10.1001/jama.280.20.1757
Members of the CDC Diabetes Cost-Effectiveness Study Group include Michael M. Engelgau, MD, K. M. Venkat Narayan, MD, Theodore J. Thompson, MS, James P. Boyle, PhD, and David F. Williamson, PhD, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga; W. Dana Flanders, MD, MSc, Division of Epidemiology, School of Public Health, Emory University, Atlanta; Diane L. Manninen, PhD, Fred B. Dong, AM, MBA, and Carlyn E. Orians, MA, Battelle Centers for Public Health Research, Seattle, Wash; Erik J. Dasbach, PhD, Merck and Company, Inc, Blue Bell, Pa; Steven M. Teutsch, Merck and Company, Inc, West Point, Pa; Richard Eastman, MD, Division of Diabetes, Endrocrinology, and Metabolic Diseases, National Institute for Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md; William H. Herman, MD, Division of Endrocrinology and Metabolism, Department of Medicine, University of Michigan, Ann Arbor; and Thomas J. Songer, PhD, Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pa.
Context.— Type 2 diabetes mellitus is a common and serious disease in the United
States, but one third of those affected are unaware they have it.
Objective.— To estimate the cost-effectiveness of early detection and treatment
of type 2 diabetes.
Design.— A Monte Carlo computer simulation model was developed to estimate the
lifetime costs and benefits of 1-time opportunistic screening (ie, performed
during routine contact with the medical care system) for type 2 diabetes and
to compare them with current clinical practice. Cost-effectiveness was estimated
for all persons aged 25 years or older, for age-specific subgroups, and for
African Americans. Data were obtained from clinical trials, epidemiologic
studies, and population surveys, and a single-payer perspective was assumed.
Costs and benefits are discounted at 3% and costs are expressed in 1995 US
Setting.— Single-payer health care system.
Participants.— Hypothetical cohort of 10,000 persons with newly diagnosed diabetes
from the general US population.
Main Outcome Measures.— Cost per additional life-year gained and cost per quality-adjusted life-year
Results.— The incremental cost of opportunistic screening among all persons aged
25 years or older is estimated at $236,449 per life-year gained and $56,649
per QALY gained. Screening is more cost-effective among younger people and
among African Americans. The benefits of early detection and treatment accrue
more from postponement of complications and the resulting improvement in quality
of life than from additional life-years.
Conclusions.— Early diagnosis and treatment through opportunistic screening of type
2 diabetes may reduce the lifetime incidence of major microvascular complications
and result in gains in both life-years and QALYs. Incremental increases in
costs attributable to screening and earlier treatment are incurred but may
well be in the range of acceptable cost-effectiveness for US health care systems,
especially for younger adults and for some subpopulations (eg, minorities)
who are at relatively high risk of developing the major complications of type
2 diabetes. Although current recommendations are that screening begin at age
45 years, these results suggest that screening is more cost-effective at younger
ages. The selection of appropriate target populations for screening should
consider factors in addition to the prevalence of diabetes.
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