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Screening for type 2 diabetes and IGT is cost-effective
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Screening for type 2 diabetes and impaired glucose tolerance in a high-risk population is cost-effective.
Researchers from the University of Leicester, United Kingdom, conducted a cost-effectiveness analysis in a hypothetical population aged 45 years and older who were at risk for diabetes. In the analysis, the researchers compared four potential screening strategies: one-off screening for type 2 diabetes; screening for type 2 diabetes and IGT with lifestyle intervention for those with IGT; screening for type 2 diabetes and IGT with pharmacological intervention for those with IGT; and no screening.
The researchers used published data from clinical trials and epidemiological studies and created a base model with a 50-year time horizon and discounting of costs and benefits at 3.5%.
The analysis demonstrated the cost-effectiveness of screening for type 2 diabetes and IGT with appropriate interventions for those with IGT. The estimated cost for each quality-adjusted life-year was $27,860 for the screening for type 2 diabetes only strategy and was subsequently lower for the screening strategies with pharmacological intervention and lifestyle intervention.
The screening for type 2 diabetes only strategy had a 49% probability of being cost-effective compared with 93% for the diabetes and IGT with lifestyle intervention strategy and 85% for the diabetes and IGT with pharmacological intervention strategy.
However, the cost-effectiveness of a strategy screening for diabetes alone with no intervention for individuals with IGT remains uncertain, according to the researchers. In addition, changing compliance and interventions or increasing the number of screens did not have a significant effect. – by Katie Kalvaitis
BMJ. 2008;doi:10.1136/bmj.39545.585289.25.
Is it cost-effective to go to a rock concert? For less than the price of a ticket to a rock concert one can be screened for diabetes. The use of cost-effectiveness to make medical decisions is an attempt to apply esoteric and very complex equations to capture and objectify man’s desires and values. In this case, is it valuable and therefore desirable to screen and treat for diabetes? However, such an approach to this question is fundamentally flawed because values and the entire evaluation process is subjective and not objective. Different people can value the exact same thing differently. Some would pay hundreds of dollars to go to a rock concert. Others, depending on the show, might not be willing to give a penny. People are not inanimate objects whose values and desires can be captured in formulas such as we do in physics or chemistry. We treat people because they are fellow human beings; not because it is ‘cost-effective.’ Are there more important things to spend money on that to decrease suffering and prolong life?
– Richard Dolinar, MD
Endocrine Today Editorial Board member