Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Diabetes Care. 2010 Jul;33(7):1484-90. doi: 10.2337/dc10-0054.
The economic costs of hyperglycemia are substantial. Early detection would allow management to prevent or delay development of diabetes and diabetes-related complications. We investigated the economic justification for screening for pre-diabetes/diabetes.
We projected health system and societal costs over 3 years for 1,259 adults, comparing costs associated with five opportunistic screening tests. All subjects had measurements taken of random plasma and capillary glucose (RPG and RCG), A1C, and plasma and capillary glucose 1 h after a 50 g oral glucose challenge test without prior fasting (GCT-pl and GCT-cap), and a subsequent diagnostic 75 g oral glucose tolerance test (OGTT).
Assuming 70% specificity screening cutoffs, Medicare costs for testing, retail costs for generic metformin, and costs for false negatives as 10% of reported costs associated with pre-diabetes/diabetes, health system costs over 3 years for the different screening tests would be GCT-pl $180,635; GCT-cap $182,980; RPG $182,780; RCG $186,090; and A1C $192,261; all lower than costs for no screening, which would be $205,966. Under varying assumptions, projected health system costs for screening and treatment with metformin or lifestyle modification would be less than costs for no screening as long as disease prevalence is at least 70% of that of our population and false-negative costs are at least 10% of disease costs. Societal costs would equal or exceed costs of no screening depending on treatment type.
Screening appears to be cost-saving compared to no screening from a health system perspective, and potentially cost-neutral from a societal perspective. These data suggest that strong consideration should be given to screening-with preventive management-and that use of GCTs may be cost-effective.
高血糖的经济成本是巨大的。早期发现将允许管理预防或延迟糖尿病和糖尿病相关并发症的发展。我们调查了筛查糖尿病前期/糖尿病的经济合理性。
我们对 1259 名成年人进行了 3 年的健康系统和社会成本预测,比较了五种机会性筛查测试相关的成本。所有受试者均接受了随机血浆和毛细血管葡萄糖(RPG 和 RCG)、A1C 以及口服 50 克葡萄糖挑战试验后 1 小时的血浆和毛细血管葡萄糖(GCT-pl 和 GCT-cap),以及随后的诊断性 75 克口服葡萄糖耐量试验(OGTT)的测量。
假设 70%的特异性筛查截止值,用于测试的医疗保险费用、零售价格的通用二甲双胍费用以及 10%的假阴性报告成本与糖尿病前期/糖尿病相关的费用,不同筛查测试的 3 年健康系统成本将是 GCT-pl 180635 美元;GCT-cap 182980 美元;RPG 182780 美元;RCG 186090 美元;A1C 192261 美元;均低于无筛查的成本,即 205966 美元。在不同的假设下,只要疾病的患病率至少为我们人群的 70%,且假阴性成本至少为疾病成本的 10%,那么用二甲双胍或生活方式改变进行筛查和治疗的预测健康系统成本将低于不筛查的成本。社会成本将与无筛查成本相等或超过,具体取决于治疗类型。
从健康系统的角度来看,与不筛查相比,筛查似乎具有成本效益,从社会角度来看,筛查可能具有成本中性。这些数据表明,应该强烈考虑进行筛查和预防管理,并且使用 GCT 可能具有成本效益。