• Thomas J Hoerger, Russell Harris, Katherine A Hicks, Katrina Donahue, Stephen Sorensen, and Michael Engelgau.
• RTI International, Research Triangle Park, North Carolina 27709, USA. tjh@rti.org
• Ann. Intern. Med. 2004 May 4; 140 (9): 689-99.

BackgroundNo randomized, controlled trial of screening for diabetes has been conducted. In the absence of direct evidence, cost-effectiveness models may provide guidance about preferred screening strategies.ObjectiveTo estimate the incremental cost-effectiveness of 2 diabetes screening strategies: screening targeted to people with hypertension and universal screening.DesignMarkov model.Data SourcesUnited Kingdom Prospective Diabetes Study, Hypertension Optimal Treatment trial, and recent cost data.Target PopulationGeneral primary care population in the United States.Time HorizonLifetime.PerspectiveHealth care system.InterventionsDiabetes screening targeted to people with hypertension and universal screening.Outcome MeasuresCost per quality-adjusted life-year (QALY) gained. Costs (in 1997 U.S. dollars) and QALYs discounted at a 3% annual rate.Results Of Base Case AnalysisAt all ages, incremental cost-effectiveness ratios were more favorable for screening targeted to people with hypertension than for universal screening. For example, at age 55 years, the cost per QALY for targeted screening compared with no screening was 34,375 dollars, whereas the cost per QALY for universal screening compared with targeted screening was 360,966 dollars. Screening was more cost-effective for ages 55 to 75 years than for younger ages.Results Of Sensitivity AnalysisIn single-way and probabilistic sensitivity analyses, findings were robust to therapy costs, screening costs, screening lead time, reduced effectiveness of intensive antihypertensive therapy, and increased relative risk reduction for stroke attributable to intensive hypertension control.LimitationsWe did not consider screening targeted to persons with dyslipidemia, and we used studies of people whose diabetes was detected clinically to estimate screening benefits.ConclusionsDiabetes screening targeted to people with hypertension is more cost-effective than universal screening. The most cost-effective strategy is targeted screening at age 55 to 75 years.

21 keywords...

hide…