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

  1. Thomas J. Hoerger, PhD (tjh{at}rti.org)1,
  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, NC
  2. 2Centers for Disease Control and Prevention, Atlanta, GA
  3. 3Departments of Internal Medicine and Epidemiology and the Michigan Diabetes Research and Training Center, University of Michigan Health System, Ann Arbor, MI
  4. 4MedStar Research Institute, Washington, DC
  5. 5Department of Medicine, Indiana University School of Medicine, Indianapolis, IN

    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.

    Footnotes

      • Received May 7, 2007.
      • Accepted August 7, 2007.

    This Article

    1. Published online before print August 13, 2007, doi: 10.2337/dc07-0885
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