BMJ  2008;336:1180-1185 (24 May), doi:10.1136/bmj.39545.585289.25 (published 21 April 2008)

Research

Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis

Clare L Gillies, lecturer in medical statistics 1, Paul C Lambert, senior lecturer in medical statistics1, Keith R Abrams, professor of medical statistics1, Alex J Sutton, reader in medical statistics1, Nicola J Cooper, MRC training fellow in health services research1, Ron T Hsu, senior clinical teaching fellow in epidemiology and public health1, Melanie J Davies, professor of diabetes medicine2, Kamlesh Khunti, professor of primary care diabetes and vascular medicine3

1 Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, 2 Department of Cardiovascular Sciences, University of Leicester, 3 Division of General Practice and Primary Health Care, Department of Health Sciences, University of Leicester

Correspondence to: C L Gillies clg13{at}le.ac.uk

Objective To compare four potential screening strategies, and subsequent interventions, for the prevention and treatment of type 2 diabetes: (a) screening for type 2 diabetes to enable early detection and treatment, (b) screening for type 2 diabetes and impaired glucose tolerance, intervening with lifestyle interventions in those with a diagnosis of impaired glucose tolerance to delay or prevent diabetes, (c) as for (b) but with pharmacological interventions, and (d) no screening.

Design Cost effectiveness analysis based on development and evaluation of probabilistic, comprehensive economic decision analytic model, from screening to death.

Setting A hypothetical population, aged 45 at time of screening, with above average risk of diabetes.

Data sources Published clinical trials and epidemiological studies retrieved from electronic bibliographic databases; supplementary data obtained from the Department of Health statistics for England and Wales, the screening those at risk (STAR) study, and the Leicester division of the ADDITION study.

Methods A hybrid decision tree/Markov model was developed to simulate the long term effects of each screening strategy, in terms of both clinical and cost effectiveness outcomes. The base case model assumed a 50 year time horizon with discounting of both costs and benefits at 3.5%. Sensitivity analyses were carried out to investigate assumptions of the model and to identify which model inputs had most impact on the results.

Results Estimated costs for each quality adjusted life year (QALY) gained (discounted at 3.5% a year for both costs and benefits) were £14 150 ({euro}17 560; $27 860) for screening for type 2 diabetes, £6242 for screening for diabetes and impaired glucose tolerance followed by lifestyle interventions, and £7023 for screening for diabetes and impaired glucose tolerance followed by pharmacological interventions, all compared with no screening. At a willingness-to-pay threshold of £20 000 the probability of the intervention being cost effective was 49%, 93%, and 85% for each of the active screening strategies respectively.

Conclusions Screening for type 2 diabetes and impaired glucose tolerance, with appropriate intervention for those with impaired glucose tolerance, in an above average risk population aged 45, seems to be cost effective. The cost effectiveness of a policy of screening for diabetes alone, which offered no intervention to those with impaired glucose tolerance, is still uncertain.


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Relevant Articles

Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore
Julia Hippisley-Cox, Carol Coupland, John Robson, Aziz Sheikh, and Peter Brindle
BMJ 2009 338: b880. [Abstract] [Full Text] [PDF]

Screening for type 2 diabetes in primary care
Peter E H Schwarz, Jiang Li, and Stefan R Bornstein
BMJ 2009 338: b973. [Extract] [Full Text]

Searching for a gem with practical uses
Domhnall MacAuley
BMJ 2009 338: b656. [Extract] [Full Text]

BMJ Group Awards—shortlisted candidates in nine categories
BMJ 2009 338: b329. [Extract] [Full Text]

Screen women with gestational diabetes for type 2 diabetes
Mark Sillender
BMJ 2008 336: 1263. [Extract] [Full Text] [PDF]

Screening for and prevention of type 2 diabetes
Elizabeth C Goyder
BMJ 2008 336: 1140-1141. [Extract] [Full Text] [PDF]

Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis
Clare L Gillies, Keith R Abrams, Paul C Lambert, Nicola J Cooper, Alex J Sutton, Ron T Hsu, and Kamlesh Khunti
BMJ 2007 334: 299. [Abstract] [Full Text] [PDF]

ABC of arterial and venous disease: Vascular complications of diabetes
Richard Donnelly, Alistair M Emslie-Smith, Iain D Gardner, and Andrew D Morris
BMJ 2000 320: 1062-1066. [Extract] [Full Text] [PDF]

Predictors of mortality in insulin dependent diabetes: 10 year observational follow up study
Peter Rossing, Philip Hougaard, Knut Borch-Johnsen, and Hans-Henrik Parving
BMJ 1996 313: 779-784. [Abstract] [Full Text]

Related external webpages:

Student BMJ: Critical appraisal

This article has been cited by other articles:

  • Patel, K C R, Minhas, R, Gill, P, Khunti, K, Clayton, R (2009). Vascular risk checks in the UK: strategic challenges for implementation. Heart 95: 866-867 [Full text]  
  • Hippisley-Cox, J., Coupland, C., Robson, J., Sheikh, A., Brindle, P. (2009). Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore. BMJ 338: b880-b880 [Abstract] [Full text]  
  • Schwarz, P. E H, Li, J., Bornstein, S. R (2009). Screening for type 2 diabetes in primary care. BMJ 338: b973-b973 [Full text]  
  • Bloomgarden, Z. T. (2009). Topics in Type 2 Diabetes and Insulin Resistance. Diabetes Care 32: e13-e19 [Full text]  
  • Wilson, N., Ashawesh, K., Smith, S., Anwar, A. (2008). The cost of screening for gestational diabetes mellitus. J Med Screen 15: 213-213 [Full text]  
  • Soares, M., Dumville, J. C (2008). Critical appraisal of cost-effectiveness and cost-utility studies in health care. Evid. Based Nurs. 11: 99-102 [Full text]  
  • Sillender, M. (2008). Screen women with gestational diabetes for type 2 diabetes. BMJ 336: 1263-1263 [Full text]  
  • Goyder, E. C (2008). Screening for and prevention of type 2 diabetes. BMJ 336: 1140-1141 [Full text]  

Rapid Responses:

Read all Rapid Responses

Isn’t it better to incorporate HbA1c concentration variations reported in UK prospective diabetes study in the model rather than using the first 10 years average values?
Arya K Kumarasena, et al.
bmj.com, 1 May 2008 [Full text]
Using the FINDRISK tool lowers the cost
James A Dunbar, et al.
bmj.com, 6 May 2008 [Full text]
fantastic progress in diabetes care
david j kinshuck
bmj.com, 24 May 2008 [Full text]
Target women with gestational diabetes
Mark Sillender
bmj.com, 26 May 2008 [Full text]
Low compliance lowers cost effectiveness
Olov Rolandsson
bmj.com, 3 Jun 2008 [Full text]
Doc2Doc Vacancy
Access jobs at BMJ Careers
Whats new online at Student BMJ