Evidence:

• A cost-effectiveness analysis published in 1998 estimated the lifetime costs and benefits of one-time opportunistic screening for type 2 diabetes. Expressed in 1995 U.S. dollars, the incremental cost of screening all adults aged 25 or older with an FBG test was found to be $236,449 per life-year gained, and $56,649 per QALY. The benefits of early detection and treatment accrue more from delay of complications and consequent improvement in quality of life than from additional life-years (136).
• Based on a cost-effectiveness analysis, screening all adults aged 25 years or older may decrease the average age at diagnosis by about 6 years and would reduce the cumulative incidence of end-stage renal disease by 26%, blindness by 35%, and lower-extremity amputations by 22%. The incidence of CVD would not be substantially reduced due to the increased survival associated with microvascular disease reduction (136).
• Screening adults aged 25 to 34 years is more cost-effective than screening older persons. Only in this population are lifetime treatment costs found to be reduced by $1275 as a result of screening, resulting in a cost of $35,768 per life-year gained and $13,376 per QALY gained (136).
• Because blacks have a higher prevalence of diabetes and diabetes complication rates, screening was found to be more cost-effective in this group than for the general population (136).
• The cost-effectiveness analysis of screening for type 2 diabetes has been criticized for its under-estimation of the benefits of screening on CVD risk and the over-estimation of microvascular risk in persons who may die of CVD before microvascular disease becomes apparent (137).
• A cost-effectiveness analysis of treatment for type 2 diabetes found that the cost-effectiveness ratio of intensive glycemic control was $41,384 per QALY, and was $51,889 per QALY for lipid-lowering treatment. Intensive hypertension control reduced costs and improved health outcomes with a ratio of -$1,959 per QALY (138).

Comments:

• None.