The cost-effectiveness of screening for type 2 diabetes. CDC Diabetes Cost-Effectiveness Study Group, Centers for Disease Control and Prevention (published erratum appears in JAMA 1999 Jan 27;281(4):325) (see comments)

摘要

CONTEXT: Type 2 diabetes mellitus is a common and serious disease in the United States, but one third of those affected are unaware they have it. OBJECTIVE: To estimate the cost-effectiveness of early detection and treatment of type 2 diabetes. DESIGN: A Monte Carlo computer simulation model was developed to estimate the lifetime costs and benefits of 1-time opportunistic screening (ie, performed during routine contact with the medical care system) for type 2 diabetes and to compare them with current clinical practice. Cost-effectiveness was estimated for all persons aged 25 years or older, for age-specific subgroups, and for African Americans. Data were obtained from clinical trials, epidemiologic studies, and population surveys, and a single-payer perspective was assumed. Costs and benefits are discounted at 3% and costs are expressed in 1995 US dollars. SETTING: Single-payer health care system. PARTICIPANTS: Hypothetical cohort of 10000 persons with newly diagnosed diabetes from the general US population. MAIN OUTCOME MEASURES: Cost per additional life-year gained and cost per quality-adjusted life-year (QALY) gained. RESULTS: The incremental cost of opportunistic screening among all persons aged 25 years or older is estimated at