Screening for Diabetes and Prediabetes Should be Cost-Saving in Patients at High Risk

  1. Lawrence S. Phillips, MD2,5,8
  1. 1Department of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
  2. 2Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
  3. 3Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
  4. 4Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
  5. 5Atlanta VA Medical Center, Decatur, Georgia
  6. 6Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia
  7. 7Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
  8. 8Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
  1. Corresponding author: Ranee Chatterjee, ranee.chatterjee{at}duke.edu

Abstract

OBJECTIVE Although screening for diabetes and prediabetes is recommended, it is not clear how best or whom to screen. We therefore compared the economics of screening according to baseline risk.

RESEARCH DESIGN AND METHODS Five screening tests were performed in 1,573 adults without known diabetes—random plasma/capillary glucose, plasma/capillary glucose 1 h after 50-g oral glucose (any time, without previous fast, plasma glucose 1 hour after a 50-g oral glucose challenge [GCTpl]/capillary glucose 1 h after a 50-g oral glucose challenge [GCTcap]), and A1C—and a definitive 75-g oral glucose tolerance test. Costs of screening included the following: costs of testing (screen plus oral glucose tolerance test, if screen is positive); costs for false-negative results; and costs of treatment of true-positive results with metformin, all over the course of 3 years. We compared costs for no screening, screening everyone for diabetes or high-risk prediabetes, and screening those with risk factors based on age, BMI, blood pressure, waist circumference, lipids, or family history of diabetes.

RESULTS Compared with no screening, cost-savings would be obtained largely from screening those at higher risk, including those with BMI >35 kg/m2, systolic blood pressure ≥130 mmHg, or age older than 55 years, with differences of up to −46% of health system costs for screening for diabetes and −21% for screening for dysglycemia110, respectively (all P < 0.01). GCTpl would be the least expensive screening test for most high-risk groups for this population over the course of 3 years.

CONCLUSIONS From a health economics perspective, screening for diabetes and high-risk prediabetes should target patients at higher risk, particularly those with BMI >35 kg/m2, systolic blood pressure ≥130 mmHg, or age older than 55 years, for whom screening can be most cost-saving. GCTpl is generally the least expensive test in high-risk groups and should be considered for routine use as an opportunistic screen in these groups.

  • Received August 28, 2012.
  • Accepted December 16, 2012.

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  1. Diabetes Care
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