The Cost-effectiveness of Screening for Type 2 Diabetes

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 dollars. 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 (QALY) gained. 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.