Cost and effectiveness of screening methods for abnormal fasting plasma glugose and undiagnosed Type 2 diabetes

Abstract

Cost-effectiveness in whether or not screening for undiagnosed type 2 diabetes in asymptomatic individuals is unknown, and policy statements on this topic are controversial. In Thailand, type 2 diabetes was implementing at national level by the Ministry of Public Health (MOPH) recommendation but screening methods have not been fully evaluated. Thus, the aims were to compare the performance, cost, and cost-effectiveness of four screening methods in identifying individuals with abnormal fasting plasma glucose and type 2 diabetes. This study was conducted among people ages 35 - 60 years old with no known type 2 diabetes and pre-diabetes (2,977 people). All subjects completed a set of screening questionnaires and followed by fasting plasma glucose (FPG) testing for those with positive result. Universal FPG testing was conducted and used as the reference for all other screening methods to compare with. One-time screening performance and costs were analyzed from both single-payer and societal perspectives. The results show that sensitivities of all screening methods were high to very high (71-92% and 65-97% respectively for abnormal fasting plasma glucose and type 2 diabetes), while the specificities were low to moderate (31-57% and 29-54% respectively for the screening of both conditions). The total cost of the most effective screening method (which was proposed by Aekplakorn et al) for abnormal fasting plasma glucose and type 2 diabetes were 165,766 and 166,477 bahts respectively. Their corresponding cost-effectiveness was 2,047 to 2,381 and 18,497 to 23,179 bahts per newly detected case from societal perspective, and 933 to 1,185 and 8,309 to 11,876 baht per newly detected case from a single-payer perspective. Thus, screening method proposed by Aekplakorn et al was the most effective and highest cost-effectiveness to identify newly detected abnormal fasting plasma glucose and type 2 diabetes cases among Thai adults