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Cost and Cost-effectiveness of Large-scale Screening for Type 1 Diabetes in Colorado

Diabetes care, 2020-07, Vol.43 (7), p.1496-1503 [Peer Reviewed Journal]

2020 by the American Diabetes Association. ;Copyright American Diabetes Association Jul 1, 2020 ;2020 by the American Diabetes Association 2020 ;ISSN: 0149-5992 ;EISSN: 1935-5548 ;DOI: 10.2337/dc19-2003 ;PMID: 32327420

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Title:
Cost and Cost-effectiveness of Large-scale Screening for Type 1 Diabetes in Colorado
Author: McQueen, R Brett ; Geno Rasmussen, Cristy ; Waugh, Kathleen ; Frohnert, Brigitte I ; Steck, Andrea K ; Yu, Liping ; Baxter, Judith ; Rewers, Marian
Subjects: Adolescent ; Autoantibodies - analysis ; Autoantibodies - blood ; Benchmarks ; Child ; Child, Preschool ; Children ; Colorado - epidemiology ; Cost analysis ; Cost assessments ; Cost control ; Cost-Benefit Analysis ; Costs ; Costs and Cost Analysis ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (insulin dependent) ; Diabetes Mellitus, Type 1 - diagnosis ; Diabetes Mellitus, Type 1 - economics ; Diabetes Mellitus, Type 1 - epidemiology ; Diabetic Ketoacidosis - economics ; Diabetic Ketoacidosis - epidemiology ; Early Diagnosis ; Epidemiology/Health Services Research ; Female ; Glycated Hemoglobin A - analysis ; Health Care Costs - statistics & numerical data ; Health Care Costs - trends ; Humans ; Hypoglycemic Agents - economics ; Ketoacidosis ; Longitudinal Studies ; Male ; Mass Screening - economics ; Mass Screening - methods ; Quality-Adjusted Life Years ; Research design ; Resource utilization ; Thresholds
Is Part Of: Diabetes care, 2020-07, Vol.43 (7), p.1496-1503
Description: To assess the costs and project the potential lifetime cost-effectiveness of the ongoing Autoimmunity Screening for Kids (ASK) program, a large-scale, presymptomatic type 1 diabetes screening program for children and adolescents in the metropolitan Denver region. We report the resource utilization, costs, and effectiveness measures from the ongoing ASK program compared with usual care (i.e., no screening). Additionally, we report a practical screening scenario by including utilization and costs relevant to routine screening in clinical practice. Finally, we project the potential cost-effectiveness of ASK and routine screening by identifying clinical benchmarks (i.e., diabetic ketoacidosis [DKA] events avoided, HbA improvements vs. no screening) needed to meet value thresholds of $50,000-$150,000 per quality-adjusted life-year (QALY) gained over a lifetime horizon. Cost per case detected was $4,700 for ASK screening and $14,000 for routine screening. To achieve value thresholds of $50,000-$150,000 per QALY gained, screening costs would need to be offset by cost savings through 20% reductions in DKA events at diagnosis in addition to 0.1% (1.1 mmol/mol) improvements in HbA over a lifetime compared with no screening for patients who develop type 1 diabetes. Value thresholds were not met from avoiding DKA events alone in either scenario. Presymptomatic type 1 diabetes screening may be cost-effective in areas with a high prevalence of DKA and an infrastructure facilitating screening and monitoring if the benefits of avoiding DKA events and improved HbA persist over long-run time horizons. As more data are collected from ASK, the model will be updated with direct evidence on screening effects.
Publisher: United States: American Diabetes Association
Language: English
Identifier: ISSN: 0149-5992
EISSN: 1935-5548
DOI: 10.2337/dc19-2003
PMID: 32327420
Source: GFMER Free Medical Journals
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Cost and Cost-effectiveness of Large-scale Screening for Type 1 Diabetes in Colorado

2020 by the American Diabetes Association. ;Copyright American Diabetes Association Jul 1, 2020 ;2020 by the American Diabetes Association 2020 ;ISSN: 0149-5992 ;EISSN: 1935-5548 ;DOI: 10.2337/dc19-2003 ;PMID: 32327420

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