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Gesundheitswesen 2005; 67: 167-171
DOI: 10.1055/s-2005-858232
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© Georg Thieme Verlag KG Stuttgart · New York

Cost-Effectiveness of Type 2 Diabetes Screening: Results from Recently Published Studies

Kosten-Nutzen-Analyse des Screenings zum Typ-2-Diabetes: Ergebnisse neuerer StudienA. Icks1 , W. Rathmann1 , B. Haastert1 , J. John2 , H. Löwel3 , R. Holle2 , G. Giani1 , for the KORA Study Group
  • 1Leibniz Institute at Heinrich Heine University, Institute of Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany
  • 2GSF National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
  • 3GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
The KORA study group consists of H.-E. Wichmann (speaker), H. Löwel, C. Meisinger, T. Illig, R. Holle, J. John and co-workers who are responsible for the design and conduct of the KORA studies.
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Publication Date:
20 July 2005 (online)

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Zusammenfassung

Typ-2-Diabetes-Screening wird von verschiedenen internationalen Diabetes-Fachgesellschaften empfohlen. Eine Literaturrecherche wurde durchgeführt, um publizierte Kosten-Nutzen-Analysen (CEA) zum Typ-2-Diabetes-Screening systematisch zu identifizieren und zu beschreiben. Drei Analysen wurden einbezogen. Eine Studie kommt aus Deutschland, basierend auf den Daten des KORA-Surveys S4 (1999/2001). Zwei Studien stammen aus den USA. Die deutsche und eine amerikanische Studie evaluierten Kosten pro entdecktem Fall als Hauptzielvariable. Im Gegensatz zu der amerikanischen Studie nahm die deutsche Studie in der Basisanalyse eine unvollständige Teilnahme an den Screeningprogrammen an. HbA1c-Test in Kombination mit dem oralen Glukose-Toleranztest (OGTT) war teurer als der OGTT oder die Nüchternblutbestimmung (fasting glucose testing), aber aufgrund einer hohen Teilnahme der Patienten an diesem Test auch am effektivsten in der Entdeckung von Fällen. Die zweite amerikanische Studie untersuchte die Lebenszeit-Cost-Effectiveness des Typ-2-Diabetes-Screenings basierend auf einem Markov-Modell und berechnete Kosten pro QALY. Daten zur Effektivität von Interventionen wurden zwei großen Interventionsstudien bei klinisch diagnostizierten (d. h. nicht mittels Screening identifizierten) Diabetespatienten entnommen. Die Autoren schlussfolgern, dass Typ-2-Diabetes-Screening kosteneffektiv ist, insbesondere ein gezieltes Screening bei älteren hypertensiven Personen. Diabetes-Screening ist potenziell kosteneffektiv. Jedoch wurde die Effektivität einer frühen Entdeckung und Behandlung des Typ-2-Diabetes bisher nicht nachgewiesen. Auch fehlen Daten zum Verlauf eines früh entdeckten Diabetes. Die wichtigste Frage für die Zukunft ist, ob Typ-2-Diabetes-Screening und die frühe Behandlung effektiv im Hinblick auf klinische Outcomes sind.

Abstract

Type 2 diabetes screening is recommended by various international diabetes associations. We conducted a literature research to identify and describe systematically recently published cost effectiveness analyses (CEA) for type 2 diabetes screening. Three analyses were included. One of them was conducted in Germany, based on the data of the KORA survey S4 (1999/2001). Two studies came from the US. The German as well as one of the US studies evaluated cost per detected diabetic case as main outcome. In contrast to the US study, the German study considered incomplete participation in the screening programs as baseline case. HbA1 c testing combined with the oral glucose tolerance test (OGTT) was more expensive than OGTT or fasting glucose testing, but also most effective in detecting cases, due to high participation in this screening strategy. The second US study investigated the lifetime cost effectiveness of type 2 diabetes screening, based on a Markov model to calculate cost per quality-adjusted life year (QALY). Effectiveness data were derived from two large intervention studies in clinically diagnosed (not identified by screening) diabetic subjects. The authors conclude that type 2 diabetes screening is cost effective, in particular targeted screening in elderly hypertensive subjects. Diabetes screening may be cost effective. However, the effectiveness of early detection and treatment of type 2 diabetes has not yet been shown, and data regarding the course of early detected diabetes are lacking so far. In the future, the most important question is whether type 2 diabetes screening and early treatment is effective with respect to clinical outcomes.

Schlüsselwörter

Cost-Effectiveness-Analyse - Strategien des Typ-2-Diabetes-mellitus-Screenings

Key words

Cost effectiveness analyses - screening strategies for undetected type 2 diabetes mellitus

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1 QALY = quality-adjusted life years

PD Dr. med. Dr. P. H. Andrea Icks

German Diabetes Center, Institute of Biometrics and Epidemiology

Auf’m Hennekamp 65

40225 Düsseldorf

Email: icks@ddz.uni-duesseldorf.de

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