Cost-Effectiveness of Screening for Pre-Diabetes Among Overweight and Obese U.S. Adults
Response to Wechowski
- Thomas J. Hoerger, PHD1,
- Katherine A. Hicks, MS1,
- Stephen W. Sorensen, PHD2,
- William H. Herman, MD, MPH345,
- Robert E. Ratner, MD6,
- Ronald T. Ackermann, MD, MPH7,
- Ping Zhang, PHD2 and
- Michael M. Engelgau, MD2
- 1Center of Excellence in Health Promotion Economics, RTI International, Research Triangle Park, North Carolina
- 2Centers for Disease Control and Prevention, Atlanta, Georgia
- 3Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
- 4Department of Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
- 5Michigan Diabetes Research and Training Center, University of Michigan Health System, Ann Arbor, Michigan;the
- 6MedStar Research Institute, Washington, D.C.
- 7Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Corresponding author: Thomas J. Hoerger, PhD, RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709. E-mail: tjh{at}rti.org
We appreciate Dr. Wechowski's interest (1) in our study (2) and agree that it is important to evaluate the cost-effectiveness of screening for pre-diabetes and of diabetes prevention on a country-by-country basis. Cost-effectiveness ratios may vary between countries because of differences in the costs of diabetes intervention, screening, general treatment, and related complications and because of differences in the prevalence of pre-diabetes.
We agree with Dr. Wechowski that the differences between his analysis for the U.K. (3) and our analysis for the U.S. are unlikely due to time horizon. Adding younger cohorts to our analysis may increase the cost-effectiveness ratio somewhat but will have relatively little effect on our overall ratio because so many overweight and obese patients are in the 45–74 years age range that we used in our analysis. Although Dr. Wechowski assumed that a more costly screening strategy was applied, adopting such a strategy would not dramatically increase our cost-effectiveness ratio; we found that doubling screening costs increased the ratio only modestly.
