Cost-Effectiveness of Periodic Screening for Diabetes and Prediabetes

Importance:Recommendations on screening asymptomatic adults for type 2 diabetes vary. The American Diabetes Association recommends that adults who are overweight or obese and have at least one additional diabetes risk factor should be screened for type 2 diabetes and prediabetes; for adults without risk factors, screening should begin at age 45.  More conservatively, the U.S. Preventive Services Task Force recommends screening among those with elevated blood pressure only, but makes no recommendation for other adults.

Objective: This study evaluates the cost-effectiveness of screening recommendations from the American Diabetes Association and the US Preventive Services Task Force, considering the benefits for detecting and treating both undiagnosed diabetes and prediabetes.

Design: A Markov simulation model of type 2 diabetes progression is used to estimate the long term health benefits and costs of detecting and treating type 2 diabetes and prediabetes via periodic screening during regularly scheduled office visits.

Setting:Physician offices.

Participants:Persons who do not have diagnosed diabetes.

Interventions:Opportunistic screening followed by diabetes treatment for persons detected with diabetes and intensive lifestyle intervention for persons detected with prediabetes.

Main Outcomes: Incremental cost effectiveness ratios are used to evaluate the cost-effectiveness of screening interventions relative to no screening and relative to one another.

Results: Relative to no screening, screening based on the American Diabetes Association and the US Preventive Services Task Force recommendations have cost-effectiveness ratios of $33,135 and $31,756 per QALY, respectively.  The American Diabetes Association recommendation calls for a larger screening population and yields a lager health benefit, producing a cost-effectiveness ratio of $34,477 per QALY relative to the US Preventive Services Task Force recommendation. Relative to less frequent screening, annual screening leads to an increase in the cost-effectiveness ratio but is still less than $50,000 per QALY for high-risk cohorts.

Conclusions and Relevance: At a societal willingness to pay of $50,000 per QALY, both the American Diabetes Association and the US Preventive Services Task Force screening recommendations are cost-effective relative to no screening. At this level of willingness to pay, the American Diabetes Association recommendation is preferred to the US Preventive Services Task Force recommendation because of a larger health benefit.