Since diabetes was the disease that started me on this journey, I’ll get into it now. I’ll break this huge issue into smaller posts. Since I went into great detail about the methods of the literature with the hypertension post, I’ll keep these shorter.
Screening for and preventing diabetes does not save money. There are a number of published cost-effectiveness analyses on these topics. A nice review appeared in Diabetes Care in 2010.
The general pattern is that the higher the risk for diabetes in a patient population, the more cost-effective the screening is. For high-risk patients, the ICER could be in the $3,000/QALY range. For lower-risk patients, or those with limited life expectancy, it can be over $1,000,000/QALY.
To prevent diabetes in high-risk patients, there is a similar pattern. These studies are one step past screening costs and assume the high-risk patient just showed up. Interventions could include interventions from lifestyle counseling to metformin treatment, in high-risk patients with pre-diabetes or impaired glucose tolerance. The range of ICERs is large, very dependent on assumptions about the underlying risk of the patient, cost assumptions, long-term outcomes, and so on. More optimistic studies in higher-risk patients calculate ICERs in the low thousands/QALY. On the other end of the spectrum, the ICER could be over $100,000/QALY.
For screening’s impact on mortality, the highest assumption in one of the major studies for increased life expectancy was 1.5 months in 25-34-year-olds. For prevention through treatment, an overall estimate for increased life expectancy in adults with impaired glucose tolerance was 3 months.
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