Screening Adults for Pre-Diabetes and Diabetes May Be Cost-Saving
- Ranee Chatterjee, MD, MPH1,2,
- K.M. Venkat Narayan, MD, MSC, MBA1,3,
- Joseph Lipscomb, PHD4,6 and
- Lawrence S. Phillips, MD5,6
- 1Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia;
- 2Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
- 3Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, Georgia;
- 4Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia;
- 5Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, Georgia;
- 6Atlanta VA Medical Center, Decatur, Georgia.
- Corresponding author: Ranee Chatterjee, rchatte2{at}jhu.edu.
Abstract
OBJECTIVE The economic costs of hyperglycemia are substantial. Early detection would allow management to prevent or delay development of diabetes and diabetes-related complications. We investigated the economic justification for screening for pre-diabetes/diabetes.
RESEARCH DESIGN AND METHODS We projected health system and societal costs over 3 years for 1,259 adults, comparing costs associated with five opportunistic screening tests. All subjects had measurements taken of random plasma and capillary glucose (RPG and RCG), A1C, and plasma and capillary glucose 1 h after a 50 g oral glucose challenge test without prior fasting (GCT-pl and GCT-cap), and a subsequent diagnostic 75 g oral glucose tolerance test (OGTT).
RESULTS Assuming 70% specificity screening cutoffs, Medicare costs for testing, retail costs for generic metformin, and costs for false negatives as 10% of reported costs associated with pre-diabetes/diabetes, health system costs over 3 years for the different screening tests would be GCT-pl $180,635; GCT-cap $182,980; RPG $182,780; RCG $186,090; and A1C $192,261; all lower than costs for no screening, which would be $205,966. Under varying assumptions, projected health system costs for screening and treatment with metformin or lifestyle modification would be less than costs for no screening as long as disease prevalence is at least 70% of that of our population and false-negative costs are at least 10% of disease costs. Societal costs would equal or exceed costs of no screening depending on treatment type.
CONCLUSIONS Screening appears to be cost-saving compared to no screening from a health system perspective, and potentially cost-neutral from a societal perspective. These data suggest that strong consideration should be given to screening—with preventive management—and that use of GCTs may be cost-effective.
Footnotes
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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.
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See accompanying editorial, p. 1695.
- Received January 13, 2010.
- Accepted March 16, 2010.
- © 2010 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
