Screening adults for diabetes could result in significant cost-savings for healthcare systems compared to the costs of not screening individuals at all, based on the findings of a diabetes screening cost analysis presented Sunday at the annual meeting of the American Diabetes Association (ADA) in New Orleans.
"The economic costs of diabetes threaten the financial integrity of our healthcare systems," said study co-author Lawrence S. Phillips, MD, from Emory University School of Medicine in Atlanta. "We asked whether there is economic justification for screening for prediabetes and unrecognized diabetes since early treatment could help prevent or delay development of diabetes and its complications and reduce associated costs."
Phillips and colleagues screened 1,259 adults who had never been diagnosed with diabetes. The volunteer participants underwent four screening tests, including random plasma and capillary glucose and a 50 g oral glucose challenge test (without a prior fast, at different times of the day) with plasma and capillary glucose measured one hour after the glucose drink. All participants also had a definitive 75 g oral glucose tolerance test (OGTT) performed in the morning after an overnight fast.
The researchers found that 24 percent of the adults screened had either diabetes or prediabetes. They also concluded that costs for screening and three years of treatment with metformin, or change in lifestyle for individuals found to have prediabetes or previously unrecognized diabetes, would be lower than costs for not screening.
The costs of two-step screening (only positive screens would have the OGTT) were projected to include the costs of testing, costs for false negatives (in individuals where the diagnosis would be missed), and costs for treatment of true positives (people found to have diabetes or prediabetes, treated with metformin, or change in lifestyle), according to the authors.
Projected healthcare system costs for diabetes screening and management over a three-year period ranged from about $180,000 to $186,000--all lower than costs for no screening, which would be about $206,000.
"These data suggest that screening with preventive management should be implemented widely and that use of the glucose challenge test may be cost-effective," Phillips said.
According to the ADA, 23.6 million U.S. children and adults, or 7.8 percent of the population, have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, 5.7 million people are unaware that they have the disease.