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Screening people with hypertension for diabetes is more cost effective than screening all patients for diabetes

In 2003, the U.S. Preventive Services Task Force recommended screening adults with hypertension (blood pressure 140/90 mm Hg or higher) or high cholesterol for type 2 (non-insulin dependent) diabetes. In 2004, a work group for the Task Force concluded that screening hypertensive patients for diabetes is more cost effective than screening all adults for diabetes. This study was supported in part by the Agency for Healthcare Research and Quality (contract 290-97-0011).

Investigators at the Research Triangle Institute/University of North Carolina, Chapel Hill Evidence-based Practice Center calculated that diabetes screening for 55-year-old people with hypertension would cost the U.S. health care system $34,375 per quality-adjusted-life-year (QALY) gained. This is similar to the cost-effectiveness of many accepted health care interventions. Expanding screening to all adults would cost an additional $360,966 per QALY, a far more costly approach.

The researchers used clinical data from several large studies and recent cost data to develop a cost-effectiveness model. The model used data on diabetes disease progression to simulate lifetime diabetes-related health care costs (including costs for complications such as heart, eye, and kidney disease) and QALYs for people with diabetes. In the model, they assumed that in the absence of screening, diabetes would be diagnosed 10 years after its onset. With a one-time screening, diabetes would be diagnosed on average 5 years after onset and patients would thus begin treatment 5 years earlier.

Based on the model, the most cost-effective approach to one-time diabetes screening is to target people with hypertension between ages 55 and 75 years. The benefit of screening comes primarily from reducing fatal and nonfatal heart attacks through intensive control of hypertension rather than from reducing microvascular complications, such as end-stage renal disease or blindness, by intensive blood-sugar control.

See "Screening for type 2 diabetes mellitus: A cost-effectiveness analysis," by Thomas J. Hoerger, Ph.D., Russell Harris, M.D., M.P.H., Katherine A. Hicks, M.S., and others, in the May 2004  Annals of Internal Medicine 140(9), pp. 689-699.

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