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The Cost-Effectiveness of Screening for Prediabetes among Overweight and Obese U.S. Adults

¹Center of Excellence in Health Promotion Economics, RTI International, Research Triangle Park, NC
²Centers for Disease Control and Prevention, Atlanta, GA
³Departments of Internal Medicine and Epidemiology and the Michigan Diabetes Research and Training Center, University of Michigan Health System, Ann Arbor, MI
⁴MedStar Research Institute, Washington, DC
⁵Department of Medicine, Indiana University School of Medicine, Indianapolis, IN

tjh{at}rti.org

ABSTRACT

Objective:To estimate the cost-effectiveness of screening overweight and obese persons for prediabetes and then modifying their lifestyle based on the Diabetes Prevention Program (DPP).

Research Design and Methods:A Markov simulation model was used to estimate disease progression, costs, and quality of life. Cost-effectiveness was evaluated from a health care system perspective. We considered 2 screening/treatment strategies for prediabetes. Strategy 1 included screening overweight persons and giving them the lifestyle intervention included in the DPP if they were diagnosed with both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Strategy 2 included screening followed by lifestyle intervention for persons diagnosed with either IGT or IFG or both. Each strategy was compared with a program of no screening.

Results:Screening for prediabetes and treating those identified as having both IGT and IFG with the DPP lifestyle intervention had a cost-effectiveness ratio of $8,181 per quality-adjusted life year (QALY) relative to no screening. If treatment was also provided to persons with only IGT or only IFG (Strategy 2), the cost-effectiveness ratio increased to $9,511 per QALY. Changes in screening-related parameters had small effects on the cost-effectiveness ratios; the results were more sensitive to changes in intervention-related parameters.

Conclusions:Screening for prediabetes in the overweight and obese U.S. population followed by the DPP lifestyle intervention has a relatively attractive cost-effectiveness ratio.

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				J. W. Wechowski Cost-Effectiveness of Screening for Pre-Diabetes Among Overweight and Obese U.S. Adults: Response to Hoerger et al. Diabetes Care, May 1, 2008; 31(5): e34 - e34. [Full Text] [PDF]

				T. J. Hoerger, K. A. Hicks, S. W. Sorensen, W. H. Herman, R. E. Ratner, R. T. Ackermann, P. Zhang, and M. M. Engelgau Cost-Effectiveness of Screening for Pre-Diabetes Among Overweight and Obese U.S. Adults: Response to Wechowski Diabetes Care, May 1, 2008; 31(5): e35 - e35. [Full Text] [PDF]