Titre du document / Document title

Cost-effectiveness analysis of different screening procedures for type 2 diabetes: The Kora Survey 2000

Auteur(s) / Author(s)

Kora Study Group, ALLEMAGNE
ICKS Andrea ⁽¹⁾ ; HAASTERT Burkhard ⁽¹⁾ ; GANDJOUR Afschin ⁽²⁾ ; JOHN Jürgen ⁽³⁾ ; LÖWEL Hannelore ⁽⁴⁾ ; HOLLE Rolf ⁽³⁾ ; GIANI Guido ⁽¹⁾ ; RATHMANN Wolfgang ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Biometrics and Epidemiology, German Diabetes Research Institute, Heinrich Heine University, Dusseldorf, ALLEMAGNE
⁽²⁾ Institute of Health, Economics, and Clinical Epidemiology, Cologne University, Cologne, ALLEMAGNE
⁽³⁾ Institute of Health, Economics, and Health Care Management, National Research Centre for Environment and Health, Neuherberg, ALLEMAGNE
⁽⁴⁾ Institute of Epidemiology, National Research Centre for Environment and Health, Neuherberg, ALLEMAGNE

Résumé / Abstract

OBJECTIVE- to compare the cost-effectiveness of different type 2 diabetes sereening strategies using population-based data (KORA Survey; Augsburg, Germany; subjects aged 55-74 years), including participation data. RESEARCH DESIGN AND METHODS- The decision analytic model, which had a time horizon of 1 year, used the following screening siraicgics: fasting glucose testing, the oral glucose tolerance test (OGTT) following lasting glucose testing in impaired fasting glucose (IFG) (fasting glucose + OGTT), OGTT only, and OGTT if HbA_1c was >5.6% (HbA₁, + OGTT), all with or without first-step preselection (p). The main outcome measures were costs (in Euros), true-positive type 2 diabetic cases, incremental cost-effectiveness ratios (ICERs), third-party payers, and societal perspectives. RESULTS- After dominated strategies were excluded, the OGTT and I HbA₁, + OGTT from the perspective of the statutory health insurance remained, as did fasting glucose + OGTT and HbA₁, + OGTT from the socictal perspective OGTTs (?4.90 per patient) yielded the lowest costs from the perspective of the statutory health insurance and fasting glucose + OGTT (?10.85) from the societal perspective HbA_1c + OGTT was the most expensive (?21.44 and ?31.77) but also the most effective (54% detected cases). ICERs, compared with the next less effective strategies, were?771 from the statutory health insurance and?831 from the societal perspective. In the Monte Carlo analysis, dominance relations remained unchanged in 100 and 68% (statutory health insurance and societal perspective, respectively) of simulated populations. CONCLUSIONS- The most effective screening strategy was HbA_1c combined with OGTT because of high participation. However, costs were lower when screening with fasting glucose tests combined with OGTT or OGTT alone. The decision regarding which is the most favorable strategy depends on whether The goal is to identify a high number of cases or to incur latter costs at reasonable effectiveness.

Revue / Journal Title

Diabetes care   ISSN 0149-5992   CODEN DICAD2 

Source / Source

2004, vol. 27, n^o9, pp. 2120-2128 [9 page(s) (article)] (22 ref.)

Langue / Language

Anglais

Editeur / Publisher

American Diabetes Association, Alexandria, VA, ETATS-UNIS  (1978) (Revue)

Mots-clés anglais / English Keywords

Endocrinopathy ; Survey ; Medical screening ; Health economy ; Cost efficiency analysis ; Cost analysis ; Type 2 diabetes ;

Mots-clés français / French Keywords

Endocrinopathie ; Enquête ; Dépistage ; Economie santé ; Analyse coût efficacité ; Analyse coût ; Diabète type 2 ;

Mots-clés espagnols / Spanish Keywords

Endocrinopatía ; Encuesta ; Descubrimiento ; Economía salud ; Análisis costo eficacia ; Análisis costo ; Diabetes de tipo 2 ;

Localisation / Location

INIST-CNRS, Cote INIST : 18054, 35400012216645.0040