ADA: Diabetes Screening Cost Effective

For middle-age or older adults and for the obese, every screening method evaluated was projected to reduce costs to the healthcare system over a three year span even when factoring in medication costs and false negatives, found Ranee Chatterjee, MD, of Johns Hopkins, and colleagues. 

When averaged across screening tests, the chance to catch cases early and potentially prevent complications actually would shave an estimated 7.3% off the healthcare costs for those with a body mass index of 25 to 35 kg/m² and 21.5% for those in the over 35 kg/m² range. For the 40- to 55-year-old set, screening would cut costs 8.1%, while the savings were 17.1% for those over 55, Chatterjee's group reported in a poster presented at the American Diabetes Association meeting.

These findings support ADA recommendations for Type 2 diabetes screening in asymptomatic adults of any age who are overweight or obese, and who have one or more additional risk factors for diabetes.

Chatterjee stated that, "Any screening at all is better than none, but the greatest bang for the healthcare buck comes from screening high-risk groups. Her group concluded that the least expensive screening method -- plasma glucose levels one hour after a 50 g oral glucose challenge -- "should be considered for routine use as an opportunistic screen."

ADA president Richard M. Bergenstal, MD, noted that the best method remains debated as do the precise groups considered high risk.

Chatterjee said that, "Many physicians and health systems have yet to adopt any screening strategy, and those that have vary widely in their approach. "I think cost is a big part of it."

But there's a clear need for it, Bergenstal explained in a press conference.

"All the data in management now says the earlier you intervene, the more effective it is, the safer it is, the easier it is.... It gets harder and harder when you try to catch up with someone six or eight or 10 years later. So with all the data saying we have to intervene early, we have to find people early."

Chatterjee's group analyzed the Screening for Impaired Glucose Tolerance Study results in which 1,573 volunteers were screened for diabetes and prediabetes using random plasma glucose and a finger prick test before and after a one hour 50 g oral glucose challenge test.

As the definitive test on the second visit, glycated hemoglobin and a standard two-hour 75 g oral glucose tolerance test were taken as well.

As expected, prevalence of diabetes or prediabetes rose with BMI (12% for underweight to 35% at obese) and age (10% before 40 to 35% over 55).

Direct costs of screening and treating with generic metformin and being seen for medical care over three years were assessed along with costs of false negatives determined as direct medical costs associated with missing a diagnosis based on Medical Expenditure Panel Survey and Kaiser data.

These costs associated with screening everyone in the study with the plasma glucose challenge test were lower than projected for no screening ($216,007 versus $242,737 for diabetes and prediabetes combined and $66,878 versus $95,710 for diabetes alone).

Testing costs to find one person with diabetes or prediabetes decreased with rising BMI from $153 per person at a BMI under 25 kg/m2 to $61 per person over 35 kg/m2. The same was true for rising age ($218 per case found in those under 40 versus $85 at 40 to 55 and $61 over 55).

Thus, the savings with screening versus no screening were the greatest in the obese ($253 versus $73 per person in the underweight group) and in the oldest age group ($239 versus $65 per person under 40).

The glucose challenge test was recommended by Chatterjee's group as perhaps a more sensitive and specific option "without putting a lot of hardship on the patient" to be fasting, she said.

But Bergenstal noted that the combination of hemoglobin A1c and fasting glucose is the ADA's preferred method.

Note: This study was published as an abstract and presented at the 70^th ADA scientific sessions. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

American Diabetes Association; Chatterjee R, et al "Screening for diabetes and prediabetes should be cost-saving in high-risk patients" ADA 2010; Abstract 65-LB.