A comparison of cost per case detected of screening strategies for Type 2 diabetes and impaired glucose regulation: Modelling study

Background: To determine a cost per case detected for different screening strategies for both Type 2 diabetes alone and in combination with impaired glucose regulation. Methods: Bayesian framework modelling study using data from the ADDITION-Leicester screening study in UK multi-ethnic primary care setting. There were 5794 people aged 40-75 years (77.4% white European; 22.6% south Asian) without previously known diabetes. We compared 212 screening strategies including blood tests, a computer practice data score and a risk score, as part of a multi-stage process that all used an oral glucose tolerance test as the diagnostic test. Simulation models were created using sensitivity estimates for the expected cost per case. Results: The estimated costs per case identified for the 18 most sensitive strategies varied from 457 pound to 1639 pound ((sic)526-1886, for 1 pound = (sic)1.15) for diabetes and 148-913 pound ((sic)170-1050) for both diabetes and impaired glucose regulation. The lowest costing diabetes strategies ranged from 457 pound to 523 pound ((sic)526-601) involving a two-stage screening strategy, a non-invasive risk stratifying tool followed by a blood test, producing sensitivities ranging from 67.1 to 82.4%. Conclusion: Screening a population using a non-invasive risk stratification tool followed by a screening blood test is the most cost-effective method of screening for diabetes and abnormal glucose tolerance. (C) 2012 Elsevier Ireland Ltd. All rights reserved.