Abstract:
OBJECTIVE:To compare the cost and time to diagnosis associated with several screening strategies for diabetes in women with histories of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS:We simulated screening for diabetes with fasting plasma glucose (FPG), a 2-h oral glucose tolerance test (OGTT), and A1C annually, every 2 years, and every 3 years over a period of 12 years. We assumed that women had negative screening tests 6 weeks after delivery, progressed to diabetes at 8% per year, and that each positive FPG and A1C was followed by a confirmatory FPG. For each strategy, we calculated the cost per case detected, cost per woman screened, the percent of cases detected, and the time elapsed with undiagnosed diabetes. In sensitivity analyses, we considered the inclusion of indirect costs, the impact of imperfect adherence to screening strategies, exclusion of confirmatory tests, and lower rates of progression to diabetes. RESULTS:When annual, biannual, or every 3-year screening strategies were utilized, OGTTs resulted in lower costs per case detected than FPG or A1C. Testing every 3 years resulted in lower costs per case detected compared with more frequent testing. These patterns persisted in sensitivity analyses, except that FPG resulted in lower cost per case detected than OGTT, assuming annual screening and inclusion of indirect costs or assuming annual screening without a confirmatory FPG. CONCLUSIONS:Screening every 3 years with OGTTs results in the lowest cost per case of detected diabetes.
journal_name
Diabetes Carejournal_title
Diabetes careauthors
Kim C,Herman WH,Vijan Sdoi
10.2337/dc06-2237subject
Has Abstractpub_date
2007-05-01 00:00:00pages
1102-6issue
5eissn
0149-5992issn
1935-5548pii
dc06-2237journal_volume
30pub_type
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