Screening for type 2 diabetes mellitus: a cost-effectiveness analysis.

BACKGROUND No 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. OBJECTIVE To estimate the incremental cost-effectiveness of 2 diabetes screening strategies: screening targeted to people with hypertension and universal screening. DESIGN Markov model. DATA SOURCES United Kingdom Prospective Diabetes Study, Hypertension Optimal Treatment trial, and recent cost data. TARGET POPULATION General primary care population in the United States. TIME HORIZON Lifetime. PERSPECTIVE Health care system. INTERVENTIONS Diabetes screening targeted to people with hypertension and universal screening. OUTCOME MEASURES Cost 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 ANALYSIS At 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 ANALYSIS In 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. LIMITATIONS We did not consider screening targeted to persons with dyslipidemia, and we used studies of people whose diabetes was detected clinically to estimate screening benefits. CONCLUSIONS Diabetes 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.