Cost-Effectiveness of Screening for Pre-Diabetes Among Overweight and Obese U.S. Adults

  1. Thomas J. Hoerger, PHD1,
  2. Katherine A. Hicks, MS1,
  3. Stephen W. Sorensen, PHD2,
  4. William H. Herman, MD, MPH3,
  5. Robert E. Ratner, MD4,
  6. Ronald T. Ackermann, MD, MPH5,
  7. Ping Zhang, PHD2 and
  8. Michael M. Engelgau, MD2
  1. 1Center of Excellence in Health Promotion Economics, RTI International, Research Triangle Park, North Carolina
  2. 2Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  3. 3Departments of Internal Medicine and Epidemiology and the Michigan Diabetes Research and Training Center, University of Michigan Health System, Ann Arbor, Michigan
  4. 4MedStar Research Institute, Washington, DC
  5. 5Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
  1. Address correspondence and reprint requests to Thomas J. Hoerger, PhD, RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709. E-mail: tjh{at}


OBJECTIVE—To estimate the cost-effectiveness of screening overweight and obese individuals for pre-diabetes 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 two screening/treatment strategies for pre-diabetes. Strategy 1 included screening overweight subjects 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 subjects diagnosed with either IGT or IFG or both. Each strategy was compared with a program of no screening.

RESULTS—Screening for pre-diabetes 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 subjects 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 pre-diabetes in the overweight and obese U.S. population followed by the DPP lifestyle intervention has a relatively attractive cost-effectiveness ratio.


  • Published ahead of print at on 13 August 2007. DOI: 10.2337/dc07-0885.

    Additional information for this article can be found in an online appendix at

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

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted August 7, 2007.
    • Received May 7, 2007.
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  1. Diabetes Care vol. 30 no. 11 2874-2879
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