Graduate School of Public Health, Clinical Epidemiology and HTA Center St. Luke's International University, 3-6-2 Akashi-cho, Chuo, Tokyo, 104-0044, Japan.
Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, #209, Research Park Bid. No. 2, 134, Minami-machi, Chudoji, Simogyo-ku,, Kyoto, 600-8813, Japan.
BMC Endocr Disord. 2021 May 22;21(1):105. doi: 10.1186/s12902-021-00771-0.
The best HbA1c test interval strategy for detecting new type 2 diabetes mellitus (T2DM) cases in healthy individuals should be determined with consideration of HbA1c test characteristics, risk stratification towards T2DM and cost effectiveness.
State transition models were constructed to investigate the optimal screening interval for new cases of T2DM among each age- and BMI-stratified health individuals. Age was stratified into 30-44-, 45-59-, and 60-74-year-old age groups, and BMI was also stratified into underweight, normal, overweight and obesity. In each model, different HbA1c test intervals were evaluated with respect to the incremental cost-effectiveness ratio (ICER) and costs per quality-adjusted life year (QALY). Annual intervals (Japanese current strategy), every 3 years (recommendations in US and UK) and intervals which are tailored to each risk stratification group were compared. All model parameters, including costs for screening and treatment, rates for complications and mortality and utilities, were taken from published studies. The willingness-to-pay threshold in the cost-effectiveness analysis was set to US $50,000/QALY.
The HbA1c test interval for detecting T2DM in healthy individuals varies by age and BMI. Three-year intervals were the most cost effective in obesity at all ages-30-44: $15,034/QALY, 45-59: $11,849/QALY, 60-74: $8685/QALY-compared with the other two interval strategies. The three-year interval was also the most cost effective in the 60-74-year-old age groups-underweight: $11,377/QALY, normal: $18,123/QALY, overweight: $12,537/QALY-and in the overweight 45-59-year-old group; $18,918/QALY. In other groups, the screening interval for detecting T2DM was found to be longer than 3 years, as previously reported. Annual screenings were dominated in many groups with low BMI and in younger age groups. Based on the probability distribution of the ICER, results were consistent among any groups.
The three-year screening interval was optimal among elderly at all ages, the obesity at all ages and the overweight in 45-59-year-old group. For those sin the low-BMI and younger age groups, the optimal HbA1c test interval could be longer than 3 years. Annual screening to detect T2DM was not cost effective and should not be applied in any population.
为了在健康个体中检测新发 2 型糖尿病（T2DM）病例，应根据糖化血红蛋白（HbA1c）检测的特点、T2DM 的风险分层以及成本效益来确定最佳的 HbA1c 检测间隔策略。
构建状态转移模型，以研究每个年龄和 BMI 分层的健康个体中新发 T2DM 的最佳筛查间隔。年龄分为 30-44 岁、45-59 岁和 60-74 岁，BMI 也分为体重过轻、正常、超重和肥胖。在每个模型中，根据增量成本效益比（ICER）和每质量调整生命年（QALY）的成本，评估不同的 HbA1c 检测间隔。比较了每年（日本现行策略）、每 3 年（美国和英国的建议）和针对每个风险分层组的间隔。所有模型参数，包括筛查和治疗费用、并发症和死亡率以及效用，均来自已发表的研究。成本效益分析中的意愿支付阈值设定为每 QALY50000 美元。
在健康个体中检测 T2DM 的 HbA1c 检测间隔因年龄和 BMI 而异。与其他两种间隔策略相比，在所有年龄组的肥胖患者中，3 年间隔最具成本效益-30-44 岁：15034 美元/QALY，45-59 岁：11849 美元/QALY，60-74 岁：8685 美元/QALY。在超重的 60-74 岁人群中，3 年间隔也最具成本效益-体重过轻：11377 美元/QALY，正常：18123 美元/QALY，超重：12537 美元/QALY，以及在 45-59 岁的超重人群中：18918 美元/QALY。在其他人群中，检测 T2DM 的筛查间隔发现长于 3 年，如前所述。在许多低 BMI 人群和年轻人群中，每年筛查均占主导地位。基于 ICER 的概率分布，结果在任何组中均一致。
在所有年龄段的老年人、所有年龄段的肥胖者以及 45-59 岁的超重者中，3 年筛查间隔是最佳的。对于那些 BMI 较低和年龄较小的人群，HbA1c 检测的最佳间隔时间可能长于 3 年。每年筛查以检测 T2DM 并不具有成本效益，不应在任何人群中应用。
