Cost-Effectiveness of Screening for Pre-Diabetes Among Overweight and Obese U.S. Adults

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Diabetes care (Impact Factor: 8.42). 12/2007; 30(11):2874-9. DOI: 10.2337/dc07-0885
Source: PubMed


To estimate the cost-effectiveness of screening overweight and obese individuals for pre-diabetes and then modifying their lifestyle based on the Diabetes Prevention Program (DPP).
A Markov simulation model was used to estimate disease progression, costs, and quality of life. Cost-effectiveness was evaluated from a health care system perspective. We considered two screening/treatment strategies for pre-diabetes. Strategy 1 included screening overweight subjects and giving them the lifestyle intervention included in the DPP if they were diagnosed with both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Strategy 2 included screening followed by lifestyle intervention for subjects diagnosed with either IGT or IFG or both. Each strategy was compared with a program of no screening.
Screening for pre-diabetes and treating those identified as having both IGT and IFG with the DPP lifestyle intervention had a cost-effectiveness ratio of $8,181 per quality-adjusted life-year (QALY) relative to no screening. If treatment was also provided to subjects with only IGT or only IFG (strategy 2), the cost-effectiveness ratio increased to $9,511 per QALY. Changes in screening-related parameters had small effects on the cost-effectiveness ratios; the results were more sensitive to changes in intervention-related parameters.
Screening for pre-diabetes in the overweight and obese U.S. population followed by the DPP lifestyle intervention has a relatively attractive cost-effectiveness ratio.

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    • "Screening for IFG/IGT is highly recommended, and the most efficient sequence of testing would be an FPG followed by a 2-hour plasma glucose after a 75 g glucose load to demonstrate the presence of combined IFG/IGT.7 Screening for prediabetes in the overweight and obese populations has been demonstrated to be cost-effective.50 More novel approaches may include the preDx® (Tethys Bioscience Inc, Emeryville, CA, USA) test, which represents a collection of variables (glycated hemoglobin [HbA1c], adiponectin, C-reactive protein, ferritin, glucose, interleukin-2 receptor A, and insulin) that have better predictive value than any single variable, which is clinically available, and a metabolomics analysis, which has suggested that glycine, lysophosphatidylcholine, and acetylcarnitine levels in plasma predict progression to diabetes.51–53 "
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    • "Preliminary data from this pilot program suggest that diabetes-coaching programs in a community pharmacy setting can effectively aid patients to establish and sustain healthy behavioral habits. This is promising as lifestyle behaviors are considered major contributors to chronic conditions such as type 2 diabetes [13] [14]. This pilot was successful in increasing participant confidence in their ability to achieve their individual goals and enhanced their outlook on the importance of achieving their self-set goals. "

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    • "Cost-effectiveness analysis can ensure that limited resources are allocated as efficiently as possible, so that decision makers can take informed decisions based on the benefits outweighing the costs [19]. Although active screening for T2D combined with subsequent lifestyle intervention is cost-effective [20] compared to the “wait and see” or “do nothing” approach that currently prevails, no study has emphasized the cost-effectiveness of culturally adapted lifestyle interventions for high-risk immigrants from Iraq. "
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