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Targeted Diabetes Screening Cost-Effective
posted 05/14/04
The most cost-effective strategy for diabetes screening is to
target efforts to individuals between 55 and 75 old who have hypertension,
results of a cost-effectiveness analysis indicate.
As reported in the Annals of Internal Medicine, Universal type 2 diabetes
screening is not cost-effective, Dr. Thomas J. Hoerger co-director of the health
economics and financing program at RTI International, in North Carolina.
Dr. Hoerger's team estimated the incremental cost-effectiveness of targeted and
universal type 2 diabetes screening using a Markov model of diabetes disease
progression to simulate lifetime diabetes-related healthcare costs and
quality-adjusted life-years (QALYs) gained by screening.
At all ages, "diabetes screening targeted at persons with hypertension is more
cost-effective than screening the general population." For example, targeted
screening of a 55-year-old hypertensive compared with no screening costs roughly
$34,375 per QALYs saved. This is "well within the range that American society is
typically willing to pay for healthcare treatments," according to a summary
statement in the journal.
In contrast, the cost of universal type 2 diabetes screening compared with
targeted screening was prohibitive at $360,966 per QALYs gained.
"It's important to screen persons with hypertension for type 2 diabetes," Dr.
Hoerger emphasized. "Because persons with diabetes and hypertension have lower
blood pressure targets than persons with hypertension and no diabetes. Thus,
knowing whether a person with hypertension also has diabetes allows doctors to
better design the person's therapy."
In an editorial, Dr. David M. Nathan of Massachusetts General Hospital in Boston
and Dr. William H. Herman of the University of Michigan in Ann Arbor, note that
the rationale for any screening program is that earlier detection will lead to
earlier intervention.
"Unfortunately, the current state of delivery of care to persons with diagnosed
diabetes in the United States does not bode well for the treatment of patients
identified through screening," they write. "Unless we optimize care after we
diagnose diabetes, screening cannot be effective or cost-effective."
Source: Diabetes In Control.com: Ann Intern Med 2004;140:689-699,756-757.
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