A US expert panel (the U.S. Preventive Services Task Force, USPSTF) has recommended that it is cost-effective to screen overweight and obese adults between the ages of 40 and 70 years for abnormal glucose levels. The USPSTF is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve health through the application of evidence-based medicine, including clinical preventive services such as screenings, counseling and preventive medication. The recommendation, announced at the New Orelans conference of the Amercian Diabetes Association may have significant policy implications including in the field of re-imbursement and insurance. According to Dr. Thomas J Hoerger, PhD, Senior Fellow in health economics and financing at RTI International, a non-profit research institute in Research Triangle Park, North Carolina, the recommendation is important “because under the Affordable Care Act, any preventive service that gets a grade A or B by the task force is then going to be covered by most health insurance plans, and most health insurance plans are going to cover it with no cost sharing”.
In research conducted by Dr. Hoerger it was found that screening overweight and obese individuals for abnormal glucose, followed up with lifestyle interventions or medical therapy management, is cost-effective, coming in at a price tag of approximately $29,000 per quality-adjusted life-year (QALY). Informing patients as early as possible that they have diabetes tends to improve outcomes and reduces the risk of the disease progressing to full diabetes, including reudction and management of the risks associated with a range of diabetic co-morbidities, including significant ocular complications.
In the research, Dr Hoerger used the diabetes cost-effectiveness model of the US Center for Disease Control (CDC). The project assumed that an annual HbA1c test would cost $13.75 in addition to a charge of $33.70 clinical time and a follow-up fasting plasma glucose test cost of $5.56 plus $3.00 for a blood draw. The model assumed that screening would detect previously undiagnosed individuals and that those identified would eventually progress along five disease pathways (nephropathy, neuropathy, retinopathy, coronary heart disease, and stroke). Under a previously existing guideline an estimated 36% of patients between 35 and 74 years would be eligible for screening however, the new gudieline increases eligibility to 62% of the same age group. According to the analysis performed, the incremental cost-effectiveness ratio (ICER) of screening under the new recommendation was $29,337 per QALY for all ages. Although this cost is slightly above a previous estimate, Dr. Hoerger explained that the QALY for the population as a whole would also increase and therefore “the new recommendation is cost-effective relative to no screening or the old USPSTF recommendation”. Societal willingness to pay for each QALY in the US system is estimated to be $50,000, while the UK NICE equivalent is priced at approximately £30,000.