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

The KORA Survey 2000

  1. Andrea Icks, MD, MPH, DRPH1,
  2. Burkhard Haastert, PHD1,
  3. Afschin Gandjour, MD, PHD, MBA2,
  4. Jürgen John, PHD3,
  5. Hannelore Löwel, MD4,
  6. Rolf Holle, PHD3,
  7. Guido Giani, PHD1,
  8. Wolfgang Rathmann, MD, MSPH1 and
  9. on behalf of the KORA Study Group
  1. 1Department of Biometrics and Epidemiology, German Diabetes Research Institute, Heinrich Heine University, Düsseldorf, Germany
  2. 2Institute of Health, Economics, and Clinical Epidemiology, Cologne University, Cologne, Germany
  3. 3Institute of Health, Economics, and Health Care Management, National Research Centre for Environment and Health, Neuherberg, Germany
  4. 4Institute of Epidemiology, National Research Centre for Environment and Health, Neuherberg, Germany
  1. 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

Abstract

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 HbA1c was >5.6% (HbA1c + 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 HbA1c + OGTT from the perspective of the statutory health insurance remained, as did fasting glucose + OGTT and HbA1c + 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. HbA1c + 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 HbA1c 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.

Footnotes

  • Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted May 26, 2004.
    • Received January 28, 2004.
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This Article

  1. doi: 10.2337/diacare.27.9.2120 Diabetes Care September 2004 vol. 27 no. 9 2120-2128
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