Cost-effectiveness of screening for pre-diabetes among overweight and obese US adults
Cost-effectiveness of screening for pre-diabetes among overweight and obese US adults
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DOI：
10.2337/dc07-0885
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发表时间：
2007-11-01
期刊：
影响因子：
16.2
通讯作者：
Engelgau, Michael M.
中科院分区：
文献类型：
--
作者：
Hoerger, Thomas J.;Hicks, Katherine A.;Engelgau, Michael M.
目的：评估在糖尿病预防计划（DPP）的基础上筛查超重和肥胖的糖尿病前期个体并改变其生活方式的成本效益。研究设计和方法：采用马尔可夫模拟模型来评估疾病进展、费用和生活质量。从卫生保健系统的角度评估成本效益。我们考虑了糖尿病前期的两种筛查/治疗策略。策略一包括筛查超重受试者，如果他们被诊断为糖耐量受损（IGT）和空腹血糖受损（IFG），则给予DPP中包括的生活方式干预。策略2包括对诊断为IGT或IFG或两者兼有的受试者进行筛查，然后进行生活方式干预。每种策略都与不进行筛选的方案进行比较。结果：对糖尿病前期进行筛查，并用DPP生活方式干预治疗同时患有IGT和IFG的患者，相对于不进行筛查，每个质量调整生命年（QALY）的成本-效果比为8181美元。如果对仅接受IGT或IFG治疗的受试者也提供治疗（策略2），成本-效果比增加到每个QALY 9,511美元。筛查相关参数的变化对成本-效果比的影响较小；结果对干预相关参数的变化更为敏感。结论：在超重和肥胖的美国人群中筛查糖尿病前期，然后进行DPP生活方式干预具有相对有吸引力的成本-效果比。
OBJECTIVE - To estimate the cost-effectiveness of screening over-weight and obese individuals for pre-diabetes and then modifying their lifestyle based on the Diabetes Prevention Program (DPP).RESEARCH DESIGN AND METHODS - A Markov simulation model was used to estimate disease progression, costs, and quality of life. Cost-effectiveness was evaluated from a health care system perspective. We considered two screening/treatment strategies for prediabetes. Strategy I included screening overweight subjects and giving them the lifestyle intervention included in the DPP if they were diagnosed with both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Strategy 2 included screening followed by lifestyle intervention for subjects diagnosed with either IGT or IFG or both. Each strategy was compared with a program of no screening.RESULTS - Screening for pre-diabetes and treating those identified as having both IGT and IFG with the DPP lifestyle intervention had a cost-effectiveness ratio of $8,181 per quality-adjusted life-year (QALY) relative to no screening. If treatment was also provided to subjects with only IGT or only IFG (strategy 2), the cost-effectiveness ratio increased to $9,511 per QALY. Changes in screening-related parameters had small effects on the cost-effectiveness ratios; the results were more sensitive to changes in intervention-related parameters.CONCLUSIONS - Screening for pre-diabetes in the overweight and obese U.S. population followed by the DPP lifestyle intervention has a relatively attractive cost-effectiveness ratio.