THE COST-EFFECTIVENESS OF SCREENING FOR TYPE-2 DIABETES

Context.-Type 2 diabetes mellitus is a common and serious disease in t he United States, but one third of those affected are unaware they hav e it. Objective.-To estimate the cost-effectiveness of early detection and treatment of type 2 diabetes. Design.-A Monte Carlo computer simu lation model was developed to estimate the lifetime costs and benefits of 1-time opportunistic screening (ie, performed during routine conta ct with the medical care system) for type 2 diabetes and to compare th em with current clinical practice. Cost-effectiveness was estimated fo r all persons aged 25 years or older, for age-specific subgroups, and for African Americans. Data were obtained from clinical trials, epidem iologic studies, and population surveys, and a single-payer perspectiv e was assumed. Costs and benefits are discounted at 3% and costs are e xpressed in 1995 US dollars. Setting.-Single-payer health care system. Participants.-Hypothetical cohort of 10000 persons with newly diagnos ed diabetes from the general US population. Main Outcome Measures.-Cos t per additional life-year gained and cost per quality-adjusted life-y ear (QALY) gained. Results.-The incremental cost of opportunistic scre ening among all persons aged 25 years or older is estimated at $236 44 9 per life-year gained and $56 649 per QALY gained. Screening is more cost-effective among younger people and among African Americans. The b enefits of early detection and treatment accrue more from postponement of complications and the resulting improvement in quality of life tha n from additional life-years. Conclusions.-Early diagnosis and treatme nt through opportunistic screening of type 2 diabetes may reduce the l ifetime incidence of major microvascular complications and result in g ains in both life-years and QALYs. Incremental increases in costs attr ibutable to screening and earlier treatment are incurred but may well be in the range of acceptable cost-effectiveness for US health care sy stems, especially for younger adults and for some subpopulations (eg, minorities) who are at relatively high risk of developing the major co mplications of type 2 diabetes. Although current recommendations are t hat screening begin at age 45 years, these results suggest that screen ing is more cost-effective at younger ages. The selection of appropria te target populations for screening should consider factors in additio n to the prevalence of diabetes.