Feasibility and cost-effectiveness of at-home self-sampling screening for type 2 diabetes: a pilot screening study in Denmark

Objective The increased use of HbA1c as a diagnostic criterion, novel methods to collect and store blood samples as well as the quality of national registers enable screening targeted individuals, who are not screened opportunistically. The study evaluates whether screening for type 2 diabetes using at-home self-sampling HbA1c tests, targeted people who have not had their HbA1c measured the last 2 years, is feasible and cost-effective. Research design and methods During a period of 9 months, the Danish Diabetes Association mailed free capillary at-home self-sampling HbA1c tests to 8,000 randomly selected individuals aged 50–75 years who had not had their HbA1c measured in the past 2 years. The screening costs per screen-detected derived from the pilot study and estimated cost savings across HbA1c levels derived from a Danish simulation study was used to estimate cost-effectiveness. Results About 38% returned a blood sample. The share of participants with HbA1c of 48 mmol/mol (6.5%) and above was 1.7% (50/2913). The screening costs were 1.207 per screen-detected with type 2 diabetes. A national screening program targeting individuals aged 50 to 75 years, who have not had their HbA1c measured within the previous 2 years, is estimated to reduce healthcare costs and productivity losses by €1514 per screen-detected, if diagnosis is moved forward by 3 years, as derived from a Danish simulation study. Hence, the total social return ratio of the screening program is estimated to €1514/ €1183=1.28. Conclusions The study suggests that screening for type 2 diabetes using at-home self-sampling HbA1c tests, targeting individuals aged 50–75, who have not had their HbA1c measured the past 2 years, is feasible and cost-effective in Denmark.