Design of stepwise screening for prediabetes and type 2 diabetes based on costs and cases detected

作者：de Graaf Gimon^*; Postmus Douwe; Bakker Stephan J L; Buskens Erik

来源：Journal of Clinical Epidemiology, 2015, 68(9): 1010-1018.

DOI：10.1016/j.jclinepi.2015.05.019

• Screening
• Decision analysis
• Primary prevention
• Technology assessment
• Health services research
• Diabetes mellitus
• Type 2
• Prediabetic state

Objectives: To provide insight into the trade-off between cost per case detected (CPCD) and the detection rate in questionnaire-based stepwise screening for impaired fasting glucose and undiagnosed type 2 diabetes.
Study Design and Setting: We considered a stepwise screening in which individuals whose risk score exceeds a predetermined cutoff value arc invited for further blood glucose testing. Using individual patient data to determine questionnaire sensitivity and specificity and external sources to determine screening costs and patient response rates, we rolled back a decision tree to estimate the CPCD and the detection rate for all possible cutoffs on the questionnaire.
Results: We found a U-shaped relation between CPCD and detection rate, with high costs per case detected at very low and very high detection rates. Changes in patient response rates had a large impact on both the detection rate and the CPCD, whereas screening costs and questionnaire accuracy mainly impacted the CPCD.
Conclusion: Our applied method makes it possible to identify a range of efficient cutoffs where higher detection rates can be achieved at an additional cost per detected patient. This enables decision makers to choose an optimal cutoff based on their willingness to pay for additional detected patients.

• 出版日期2015-9