Diabetes screening is “cost effective” when people begin it at ages 30 to 45 and undergo tests every three to five years, U.S. and European researchers concluded on the basis of computer modeling techniques.
Screening at that interval helps improve quality of life and prevents complications such as blindness, at a cost of $10,500 or less for each year of health gained compared with almost $41,000 a year under “maximum” screening that buys more time, according to a study published today in the journal Lancet. There are no clinical studies to validate the computer model, the scientists said.
Cost-effectiveness studies highlight the tradeoffs involved as the U.S. tries to drive up health quality and reduce medical costs -- goals that can be in conflict. The study didn’t recommend “maximum” screening, or tests every six months, citing the expense.
“It costs a fortune to do maximum screening,” said Richard Kahn, the lead author and a clinical professor of medicine at the University of North Carolina, in Chapel Hill, in a telephone interview today.
The research was funded by three drug companies: Bagsvaerd, Denmark-based Novo Nordisk A/S; Bayer AG, of Leverkusen, Germany, and New York-based Pfizer Inc. The companies sell diabetes drugs, and can benefit when screening finds more cases.
By 2034, about 44 million Americans will be living with diabetes, almost twice the number today, and spending for the disease will almost triple to $336 billion annually, according to a study published last year by University of Chicago researchers.
5.7 Million Undiagnosed
The separate study released today “gives us important information for when you should start screening for this very important, serious disease,” Kahn said.
In type 2, the most common form of diabetes, the body doesn’t produce enough of the hormone insulin, needed for the body to convert blood sugar to energy, or the cells ignore the insulin, according to the National Institutes of Health, in Bethesda, Maryland. Type 2 is linked to age, obesity and lack of exercise, according to the American Diabetes Association, of Alexandria, Virginia.
About 18 million Americans have been diagnosed with diabetes and an estimated 5.7 million are undiagnosed, according to the American Diabetes Association. About 57 million people have a precursor condition called pre-diabetes, the association said.
People who have the earliest stages of diabetes usually don’t have many symptoms. By the time diagnosis occurs, the patients may have complications such as blindness, kidney damage and heart disease.
Comparing Strategies
The researchers in today’s study created a simulated population of 325,000 people aged 30 years who didn’t have diabetes. The scientists used computer modeling to compare eight different screening strategies and their effects on quality of life, heart attacks, stroke and diabetes-related complications.
Adjusting for quality, patients gained 7.84 years of healthy life under “maximum” screening in the computer model, meaning tests every six months beginning at age 30, according to the report. That compared with 6.3 years under screening begun at age 30 and occurring every three years and 5.33 years for three-year screenings begun at age 45.
The costs would decrease if diabetes testing were combined with screening for other disorders such as high cholesterol, the authors said.
The American Diabetes Association currently recommends that screening for type 2 diabetes should be considered in people without diabetes symptoms who are overweight or obese or have other risk factors. In people without those risks, screenings should begin at age 45 and be repeated at least every three years if the initial test is normal, according to the association.
Drug Interests
Novo Nordisk won U.S. approval in January for the diabetes treatment Victoza, which belongs to a newer class of medicines that boost insulin production. Bayer, along with partner Regeneron Pharmaceuticals Inc. of Tarrytown, New York, is testing an experimental drug that may help people with vision loss related to diabetes.
Bayer also sells blood glucose monitoring equipment. Pfizer makes the diabetes medicines Glucotrol and Diabinese, both available in the U.S. as generics.
SOURCE: businessweek
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