Jin Zixuan, Rothwell Joshua, Lim Ka Keat
School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine/MPH Graduate, King's College London, London, England, UK.
GKT School of Medical Education, Faculty of Life Sciences & Medicine/MBBS Student, King's College London, London, England, UK; Department of Radiology, School of Clinical Medicine/PhD Student, University of Cambridge, Cambridge, England, UK.
Value Health. 2025 Jun;28(6):959-974. doi: 10.1016/j.jval.2025.01.001. Epub 2025 Jan 27.
To examine recent economic evaluations and understand whether any type 2 diabetes mellitus (T2DM) screening designs may represent better value for money and to rate their methodological qualities.
We systematically searched 3 concepts (economic evaluations [EEs], T2DM, screening) in 5 databases (Medline, Embase, EconLit, Web of Science, and Cochrane) for EEs published between 2010 and 2023. Two independent reviewers screened for and rated their methodological quality (using the Consensus on Health Economics Criteria Checklist-Extended).
Of 32 EEs, a majority were from high-income countries (69%). Half used single biomarkers (50%) to screen adults ≥30 to <60 years old (60%) but did not report locations (69%), treatments for those diagnosed (66%), diagnostic methods (57%), or screening intervals (54%). Compared with no screening, T2DM screening using single biomarkers was found to be not cost-effective (23/54 comparisons), inconclusive (16/54), dominant (11/54), or cost-effective (4/54). Compared with no screening, screening with a risk score and single biomarkers was found to be cost-effective (21/40) or dominant (19/40). The risk score alone was mostly dominant (6/10). Compared with universal screening, targeted screening among obese, overweight, or older people may be cost-effective or dominant. Compared with fasting plasma glucose or fasting capillary glucose, screening using risk scores was found to be mostly dominant or cost-effective. Expanding screening locations or lowering HbA1c or fasting plasma glucose thresholds was found to be dominant or cost-effective. Each EE had 4 to 17 items (median 13/20) on Consensus on Health Economics Criteria Checklist-Extended rated "Yes/Rather Yes."
EE findings varied based on screening tools, intervals, locations, minimum screening age, diagnostic methods, and treatment. Future EEs should more comprehensively report screening designs and evaluate T2DM screening in low-income countries.
研究近期的经济评估，了解是否有任何2型糖尿病（T2DM）筛查设计可能具有更高的性价比，并对其方法学质量进行评级。
我们在5个数据库（Medline、Embase、EconLit、Web of Science和Cochrane）中系统搜索了3个概念（经济评估[EEs]、T2DM、筛查），以查找2010年至2023年发表的EEs。两名独立评审员对其方法学质量进行筛选和评级（使用《卫生经济学标准共识清单-扩展版》）。
在32项EEs中，大多数来自高收入国家（69%）。一半的研究使用单一生物标志物（50%）筛查30岁及以上至60岁以下的成年人（60%），但未报告地点（69%）、对确诊者的治疗（66%）、诊断方法（57%）或筛查间隔（54%）。与不进行筛查相比，使用单一生物标志物进行T2DM筛查被发现不具有成本效益（23/54项比较）、结果不确定（16/54）、占优（11/54）或具有成本效益（4/54）。与不进行筛查相比，使用风险评分和单一生物标志物进行筛查被发现具有成本效益（21/40）或占优（19/40）。仅风险评分大多具有占优性（6/10）。与普遍筛查相比，在肥胖、超重或老年人中进行针对性筛查可能具有成本效益或占优。与空腹血糖或空腹毛细血管血糖相比，使用风险评分进行筛查大多具有占优性或成本效益。扩大筛查地点或降低糖化血红蛋白或空腹血糖阈值被发现具有占优性或成本效益。每项EE在《卫生经济学标准共识清单-扩展版》上有4至17项（中位数13/20）被评为“是/相当是”。
EEs的结果因筛查工具、间隔、地点、最低筛查年龄、诊断方法和治疗而异。未来的EEs应更全面地报告筛查设计，并评估低收入国家的T2DM筛查。
