Icks Andrea, Haastert Burkhard, Gandjour Afschin, John Jürgen, Löwel Hannelore, Holle Rolf, Giani Guido, Rathmann Wolfgang
German Diabetes Research Institute, Department of Biometrics and Epidemiology, Heinrich Heine University, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
Diabetes Care. 2004 Sep;27(9):2120-8. doi: 10.2337/diacare.27.9.2120.
To compare the cost-effectiveness of different type 2 diabetes screening strategies using population-based data (KORA Survey; Augsburg, Germany; subjects aged 55-74 years), including participation data.
The decision analytic model, which had a time horizon of 1 year, used the following screening strategies: fasting glucose testing, the oral glucose tolerance test (OGTT) following fasting glucose testing in impaired fasting glucose (IFG) (fasting glucose + OGTT), OGTT only, and OGTT if HbA(1c) was >5.6% (HbA(1c) + 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.
After dominated strategies were excluded, the OGTT and HbA(1c) + OGTT from the perspective of the statutory health insurance remained, as did fasting glucose + OGTT and HbA(1c) + OGTT from the societal 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.
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 lower costs at reasonable effectiveness.
利用基于人群的数据（德国奥格斯堡的KORA调查；55 - 74岁受试者），包括参与数据，比较不同2型糖尿病筛查策略的成本效益。
决策分析模型的时间跨度为1年，采用以下筛查策略：空腹血糖检测、空腹血糖受损（IFG）时在空腹血糖检测后进行口服葡萄糖耐量试验（OGTT）（空腹血糖 + OGTT）、仅OGTT以及糖化血红蛋白（HbA₁c）>5.6%时进行OGTT（HbA₁c + OGTT），所有策略均有或无第一步预选（p）。主要结局指标为成本（欧元）、2型糖尿病真阳性病例、增量成本效益比（ICER）、第三方支付者以及社会视角。
排除劣势策略后，从法定医疗保险角度来看，OGTT和HbA₁c + OGTT留存下来，从社会视角来看，空腹血糖 + OGTT和HbA₁c + OGTT留存下来。从法定医疗保险角度来看，OGTT（每位患者4.90欧元）成本最低，从社会视角来看，空腹血糖 + OGTT（10.85欧元）成本最低。HbA₁c + OGTT最昂贵（分别为21.44和31.77欧元），但也是最有效的（检测出54%的病例）。与次低效策略相比，ICER从法定医疗保险角度为771，从社会视角为831。在蒙特卡洛分析中，在100%（法定医疗保险）和68%（社会视角）的模拟人群中，优势关系保持不变。
由于参与率高，最有效的筛查策略是HbA₁c联合OGTT。然而，当采用空腹血糖检测联合OGTT或仅OGTT进行筛查时，成本较低。关于哪种策略最有利的决策取决于目标是识别大量病例还是在合理有效性的情况下降低成本。
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