Cost and Cost-effectiveness of Large-scale Screening for Type 1 Diabetes in Colorado
Cost and Cost-effectiveness of Large-scale Screening for Type 1 Diabetes in Colorado
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DOI：
10.2337/dc19-2003
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发表时间：
2020-07-01
期刊：
影响因子：
16.2
通讯作者：
Rewers, Marian
中科院分区：
文献类型：
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作者：
McQueen, R. Brett;Geno Rasmussen, Cristy;Rewers, Marian
目的评估成本和项目的潜在终身成本效益正在进行的自身免疫筛查儿童（ASK）计划，大规模的，症状前1型糖尿病筛查计划的儿童和青少年在丹佛大都市地区。研究设计和方法我们报告了与常规护理相比，正在进行的ASK计划的资源利用、成本和有效性措施（即，无筛选）。此外，我们报告了一个实际的筛选方案，包括利用率和成本相关的常规筛选在临床实践中。最后，我们通过确定临床基准（即，避免糖尿病酮症酸中毒[DKA]事件，HbA（1c）改善vs.无筛查）需要满足终生范围内每质量调整生命年（QALY）获得50，000 - 150，000美元的价值阈值。结果发现的每个病例的成本为ASK筛查4，700美元，常规筛查14，000美元。为了达到每QALY获得50，000 - 150，000美元的价值阈值，筛查成本需要通过诊断时DKA事件减少20%以及与未筛查的1型糖尿病患者相比终生HbA（1c）改善0.1%（1.1 mmol/mol）来抵消。在任一情况下，仅避免DKA事件均未达到价值阈值。结论：如果避免DKA事件和改善HbA（1c）的益处在长期持续，那么在DKA患病率高的地区和促进筛查和监测的基础设施中，症状前1型糖尿病筛查可能具有成本效益。随着从ASK收集到更多数据，将使用筛选效应的直接证据更新模型。
OBJECTIVE To assess the costs and project the potential lifetime cost-effectiveness of the ongoing Autoimmunity Screening for Kids (ASK) program, a large-scale, presymptomatic type 1 diabetes screening program for children and adolescents in the metropolitan Denver region. RESEARCH DESIGN AND METHODS We report the resource utilization, costs, and effectiveness measures from the ongoing ASK program compared with usual care (i.e., no screening). Additionally, we report a practical screening scenario by including utilization and costs relevant to routine screening in clinical practice. Finally, we project the potential cost-effectiveness of ASK and routine screening by identifying clinical benchmarks (i.e., diabetic ketoacidosis [DKA] events avoided, HbA(1c)improvements vs. no screening) needed to meet value thresholds of $50,000-$150,000 per quality-adjusted life-year (QALY) gained over a lifetime horizon. RESULTS Cost per case detected was $4,700 for ASK screening and $14,000 for routine screening. To achieve value thresholds of $50,000-$150,000 per QALY gained, screening costs would need to be offset by cost savings through 20% reductions in DKA events at diagnosis in addition to 0.1% (1.1 mmol/mol) improvements in HbA(1c)over a lifetime compared with no screening for patients who develop type 1 diabetes. Value thresholds were not met from avoiding DKA events alone in either scenario. CONCLUSIONS Presymptomatic type 1 diabetes screening may be cost-effective in areas with a high prevalence of DKA and an infrastructure facilitating screening and monitoring if the benefits of avoiding DKA events and improved HbA(1c)persist over long-run time horizons. As more data are collected from ASK, the model will be updated with direct evidence on screening effects.