Screening adults for pre-diabetes and diabetes may be cost-saving.
Screening adults for pre-diabetes and diabetes may be cost-saving.
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DOI：
10.2337/dc10-0054
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发表时间：
2010-07
期刊：
影响因子：
16.2
通讯作者：
Phillips LS
中科院分区：
文献类型：
--
作者：
Chatterjee R;Narayan KM;Lipscomb J;Phillips LS
高血糖症的经济成本是巨大的。早期检测将允许管理，以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。我们预测了1,259名成年人3年内的卫生系统和社会成本，比较了与5种机会性筛查测试相关的成本。所有受试者在未经禁食的情况下进行50 g口服葡萄糖激发试验（GCT-pl和GCT-cap）后1 h测量随机血浆和毛细血管葡萄糖（RPG和RCG）、A1 C以及血浆和毛细血管葡萄糖，随后进行诊断性75 g口服葡萄糖耐量试验（OGTT）。假设70%的特异性筛查临界值、医疗保险测试成本、仿制药二甲双胍的零售成本以及假阴性成本占糖尿病前期/糖尿病相关报告成本的10%，则3年内不同筛查测试的卫生系统成本将为GCT-pi 180，635美元; GCT-cap 182，980美元; RPG 182，780美元; RCG 186，090美元;和A1 C 192,261美元;所有这些都低于不进行筛查的费用，即205966美元。在不同的假设下，只要疾病患病率至少为我们人口的70%，假阴性成本至少为疾病成本的10%，那么二甲双胍筛查和治疗或生活方式改变的预计卫生系统成本将低于不筛查的成本。根据治疗类型，社会成本将等于或超过不筛查的成本。从卫生系统的角度来看，筛查似乎比不筛查节省成本，从社会角度来看，筛查可能是成本中性的。这些数据表明，应大力考虑筛查与预防性管理，并使用GCT可能具有成本效益。
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.