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Cost-Effectiveness Analysis of Different Screening Procedures for Type 2 Diabetes

The KORA Survey 2000

¹ Department of Biometrics and Epidemiology, German Diabetes Research Institute, Heinrich Heine University, Düsseldorf, Germany
² Institute of Health, Economics, and Clinical Epidemiology, Cologne University, Cologne, Germany
³ Institute of Health, Economics, and Health Care Management, National Research Centre for Environment and Health, Neuherberg, Germany
⁴ Institute of Epidemiology, National Research Centre for Environment and Health, Neuherberg, Germany

Address correspondence and reprint requests to Andrea Icks, MD, MPH, German Diabetes Research Institute, Department of Biometrics and Epidemiology, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany. E-mail: icks{at}ddfi.uni-duesseldorf.de

OBJECTIVE—To compare the cost-effectiveness of different type 2 diabetes screening strategies using population-based data (KORA Survey; Augsburg, Germany; subjects aged 55–74 years), including participation data.

RESEARCH DESIGN AND METHODS—The decision analytic model, which had a time horizon of 1 year, used the following screening strategies: fasting glucose testing, the oral glucose tolerance test (OGTT) following fasting glucose testing in impaired fasting glucose (IFG) (fasting glucose + OGTT), OGTT only, and OGTT if HbA_1c was >5.6% (HbA_1c + OGTT), all with or without first-step preselection (p). The main outcome measures were costs (in Euros), true-positive type 2 diabetic cases, incremental cost-effectiveness ratios (ICERs), third-party payers, and societal perspectives.

RESULTS—After dominated strategies were excluded, the OGTT and HbA_1c + OGTT from the perspective of the statutory health insurance remained, as did fasting glucose + OGTT and HbA_1c + OGTT from the societal perspective. OGTTs (4.90 per patient) yielded the lowest costs from the perspective of the statutory health insurance and fasting glucose + OGTT (10.85) from the societal perspective. HbA_1c + OGTT was the most expensive (21.44 and 31.77) but also the most effective (54% detected cases). ICERs, compared with the next less effective strategies, were 771 from the statutory health insurance and 831 from the societal perspective. In the Monte Carlo analysis, dominance relations remained unchanged in 100 and 68% (statutory health insurance and societal perspective, respectively) of simulated populations.

CONCLUSIONS—The most effective screening strategy was HbA_1c combined with OGTT because of high participation. However, costs were lower when screening with fasting glucose tests combined with OGTT or OGTT alone. The decision regarding which is the most favorable strategy depends on whether the goal is to identify a high number of cases or to incur lower costs at reasonable effectiveness.

Abbreviations: CER, cost-effective ratio • ICER, incremental cost-effectiveness ratios • IFG, impaired fasting glucose • OGTT, oral glucose tolerance test

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