Cost analysis of a diagnostic screening programme for differentiating type1 and 2 diabetes mellitus in persons aged between 30 and 45 years: a health-economic model for calculating comperative costs

Background and objective: Because of its chronic course and increasing inci dence diabetes mellitus is assuming increasing importance not only for medi cal reasons but also on health policy. Early recognition of carriers of aut oantibodies among type 2 diabetics (noninsulin-dependent; NIDDM) and the re sulting optimization of blood glucose could lead to a reduction of secondar y diseases. A health-economic model for calculating costs was used to test the socioeconomic significance of a screening programme for identifying car riers of antibodies against glutamic acid decarboxylase among NIDDM diabeti cs. Patients and methods: Health-economic analysis was based on the incidence o f positive autoantibody tests among diabetics aged between 30 and 45 years. Results for a cohort of diabetics who had been screened were compared with those obtained in a control group without screening. A time-span of 20 yea rs was chosen because of the tate manifestations of diseases secondary to D M. The model calculations used a cost analysis. Data were based on interven tional clinical and epidemiological studies. Cost of treatment of secondary diseases was confined to a one-year period. In the first instance the dire ct medical costs and additionally the indirect economic costs, generated by patients' loss of production and disability to work were calculated. One-d imensional sensitivity analysis was used to check the assumptions underlyin g the model. Results: Per patient in the model, total costs of the screening programme o ver a period of 20 years were calculated at DM 31 278, of which DM 7 799 we re direct and DM 23 479 indirect costs. The calculated costs for the contro l subjects (no screening) were DM 35 290, of which DM 10 984 were direct an d DM 24 306 indirect costs. Conclusions: Extrapolating to the entire population, with an investment by the statuatory health insurances of ca. DM 22.8 million, employing a full s creening programme would lead to a saving of DM 2.6 billion.