Cost-Effectiveness of Type 2 Diabetes Screening: Results from Recently Published Studies
Leibniz Institute at Heinrich Heine University, Institute of Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany. Das Gesundheitswesen
(Impact Factor: 0.62).
09/2005; 67 Suppl 1(S 01):S167-71. DOI: 10.1055/s-2005-858232
Type 2 diabetes screening is recommended by various international diabetes associations. We conducted a literature research to identify and describe systematically recently published cost effectiveness analyses (CEA) for type 2 diabetes screening. Three analyses were included. One of them was conducted in Germany, based on the data of the KORA survey S4 (1999/2001). Two studies came from the US. The German as well as one of the US studies evaluated cost per detected diabetic case as main outcome. In contrast to the US study, the German study considered incomplete participation in the screening programs as baseline case. HbA1 c testing combined with the oral glucose tolerance test (OGTT) was more expensive than OGTT or fasting glucose testing, but also most effective in detecting cases, due to high participation in this screening strategy. The second US study investigated the lifetime cost effectiveness of type 2 diabetes screening, based on a Markov model to calculate cost per quality-adjusted life year (QALY). Effectiveness data were derived from two large intervention studies in clinically diagnosed (not identified by screening) diabetic subjects. The authors conclude that type 2 diabetes screening is cost effective, in particular targeted screening in elderly hypertensive subjects. Diabetes screening may be cost effective. However, the effectiveness of early detection and treatment of type 2 diabetes has not yet been shown, and data regarding the course of early detected diabetes are lacking so far. In the future, the most important question is whether type 2 diabetes screening and early treatment is effective with respect to clinical outcomes.
Available from: George Bakris
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ABSTRACT: The aim of this study is to compare out- and inpatient health services utilization by obese and normal weight adults. In a subsample of the KORA-Survey S4 1999/2001 in the Augsburg region, Germany (n = 947, age: 25-74 years), number of visits to general practitioners (GP) and inpatient hospital days were self-reported in three computer-aided telephone interviews (CATI) over half a year. Body mass index, based on measured body height and weight, was used to define obesity according to WHO classification. Participants, stratified in normal weight (18.5 < or = BMI < 25), preobese (25 < r = BMI < 30), obese class 1 (30 < or = BMI < 35) and obese classes 2-3 (BMI > or = 35), were compared via logistic, zero-truncated negative binomial, and multinomial models to elucidate obesity's associations with utilization at all, its frequency, and high utilization. Sex, age, social class, health insurance, and place of residence were adjusted for in all models. Respondents in obesity class 1 were more prone to report at least one visit to a GP than those normal weight (OR = 1.84, p < 0.01), while obesity classes 2-3 were associated with frequent (IRR = 1.63, p < 0.05) and high utilization (OR = 3.57, p < 0.05). Regarding days in hospital, only the extremely obese (i. e. classes 2-3) reported significantly more utilization than those normal weight (days if hospitalized at all: IRR = 3.24, p < 0.05; high utilization: OR = 5.4, p < 0.01). Sex did not play a significant role in any model. Older respondents reported more utilization in terms of GP-visits, while only tending to do so regarding inpatient utilization. Both those with statutory (vs. private) health insurance and rural (vs. urban) place of residence had higher odds to visit a GP at all. Results point to an excess utilization of out- and inpatient health services by especially extremely obese adults, and underline the need to contrast obesity classes 2-3 vs. 1 in health services utilization research.
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ABSTRACT: The KORA studies serve as a powerful tool for the genetic analysis of complex diseases like type 2 diabetes or the metabolic syndrome. These studies include more than 2,000 prevalent and incident type 2 diabetes cases. DNA of these patients is available to be used in genetic studies. Up to now the analyses have focussed on genes coding for proteins being involved in the inflammatory response. Interleukin-6 (IL-6) as the key mediator of the acute phase reaction is of interest. Elevated protein concentrations of IL-6 in the blood have been shown to predict type 2 diabetes. We investigated the association of the IL-6 single nucleotide polymorphism (SNP) C-174G with type 2 diabetes in a case-control study of 704 elderly participants of the KORA Survey S4 (1999/2001). When BMI, HDL cholesterol, physical activity, hypertension, hormone replacement therapy and smoking were considered as covariables the SNP C-174G showed a trend for association with type 2 diabetes (- 174G: OR 1.20, 95 % CI 0.90 - 1.59, p = 0.21).
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