Screening for type 2 diabetes mellitus: a cost-effectiveness analysis.

Abstract

No randomized, controlled trial of screening for diabetes has been conducted. In the absence of direct evidence, cost-effectiveness models may provide guidance about preferred screening strategies. To estimate the incremental cost-effectiveness of 2 diabetes screening strategies: screening targeted to people with hypertension and universal screening. Markov model. United Kingdom Prospective Diabetes Study, Hypertension Optimal Treatment trial, and recent cost data. General primary care population in the United States. Lifetime. Health care system. Diabetes screening targeted to people with hypertension and universal screening. Cost per quality-adjusted life-year (QALY) gained. Costs (in 1997 U.S. dollars) and QALYs discounted at a 3% annual rate. At all ages, incremental cost-effectiveness ratios were more favorable for screening targeted to people with hypertension than for universal screening. For example, at age 55 years, the cost per QALY for targeted screening compared with no screening was 34,375 dollars, whereas the cost per QALY for universal screening compared with targeted screening was 360,966 dollars. Screening was more cost-effective for ages 55 to 75 years than for younger ages. In single-way and probabilistic sensitivity analyses, findings were robust to therapy costs, screening costs, screening lead time, reduced effectiveness of intensive antihypertensive therapy, and increased relative risk reduction for stroke attributable to intensive hypertension control. We did not consider screening targeted to persons with dyslipidemia, and we used studies of people whose diabetes was detected clinically to estimate screening benefits. Diabetes screening targeted to people with hypertension is more cost-effective than universal screening. The most cost-effective strategy is targeted screening at age 55 to 75 years.