Systematic literature review of the health economic implications of early detection by screening populations at risk for type 2 diabetes

Abstract

Background: Undetected/uncontrolled diabetes is associated with substantial morbidity and mortality and consequent costs. Early detection through screening identifies patients at risk, allowing for earlier treatment initiation.

Objectives: To determine the economic impact of screening for type 2 diabetes (T2DM).

Data sources: We systematically reviewed health economic analyses of screening programs for T2DM/pre-diabetes.

Study eligibility criteria: Published between 2000 and 2015 in any language. Articles must have reported costs of screening, test/patient outcomes and cost-effectiveness.

Participants and interventions: Any type of screening (universal, targeted, opportunistic) was accepted.

Methods: Data were extracted from Scopus/Medline/Embase, then tabulated.

Results: There were 137 studies identified, 108 rejected; 29 were analyzed. Screening types included 18 universal, 8 targeted and 8 opportunistic. One study screened for pre-diabetes, 16 for T2DM and 12 examined both. Fourteen (48%) reported costs of screening only, 9 (31%) costs of screening combined with interventions and 6 (21%) presented all costs separately. Screening was compared to no screening in 13 studies (45%); screening was cost-effective in 8 (62%), not cost-effective in 4 (31%) and neither in 1 (8%). When comparing different screening methods, 6 found targeted screening was cost-effective compared with universal screening (none found the opposite), 2 found opportunistic superior to universal. Sensitivity analyses generally confirmed primary findings. Cost drivers included prevalence of T2DM/pre-diabetes, type of blood test used and uptake of testing. For optimal cost-effectiveness, screening for both T2DM and pre-diabetes should be initiated around age 45–50, with repeated testing every 5 years.

Conclusions/implications: Targeted screening appears to be cost-effective compared to universal screening.

Keywords:

• Cost-effectiveness
• screening
• type 2 diabetes

Transparency

Declaration of funding

Funded by Novo Nordisk A/S, Bagsværd, Denmark. This study was performed independently from the sponsor, who had no input into the development of the protocol, data collection, data management/interpretation, or manuscript preparation.

Author contributions: T.R.E. and B.G.B. conducted the search, extracted and verified data, wrote and edited the manuscript and approved the final version. A.A. and R.J. conceived of the project, assisted in the research design, edited/revised it and approved the final manuscript.

Declaration of financial/other relationships

T.R.E., B.G.B., A.A., and R.J. have disclosed that they received funding for participating in this research as consultants and have all previously done research on diabetes for Novo Nordisk and Janssen.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.