Screening for type 2 diabetes in middle-aged adults may lead to savings in healthcare costs — specifically among high-risk patients in whom diabetes is detected — new research suggests.
“The relatively modest cost of screening per person discovered to have developed diabetes was offset within 2 years by savings in the healthcare system,” Camilla Sortsø, a PhD student at Aarhus University in Denmark, and colleagues report in a study published online March 16 in Diabetologia.
These findings suggest there are “potential cost savings” for inpatient, outpatient, and primary care services, and prescription drugs from “early detection and treatment among individuals at high risk of diabetes,” according to the authors.
The results extend previous work by the group, which showed that although screening for type 2 diabetes did not improve short-term survival or decrease the risk of cardiovascular disease in the general population, there was a benefit for patients with newly discovered type 2 diabetes.
The earlier work showed that patients in the screening program were diagnosed with diabetes 2.1 years earlier than other patients. And a “single round of diabetes screening and cardiovascular risk assessment, was associated with a 16% risk reduction in cardiovascular disease and a 21% reduction in all-cause mortality” during follow-up, senior author Torsten Lauritzen, MD, DMSc, also from Aarhus University, said in a statement issued by the university on publication of the current study.
In this latest work, the researchers estimate that among patients diagnosed with type 2 diabetes, average healthcare costs over the next 5 years were roughly US $3,300 lower per patient for those in the screening group.
Earlier Diagnosis, Lower Healthcare Costs?
In this register-based, nonrandomized controlled trial, eligible individuals were men and women aged 40 to 69 years without known diabetes registered with a general practice in Denmark in 2001 (n = 1,912,392). Of these, 153,107 individuals were registered with 181 practices participating in the ADDITION-Denmark study and were sent a diabetes risk-score questionnaire between 2001 to 2006.
The remaining 1,759,285 individuals registered with all other practices in Denmark constituted the retrospective no-screening (control) group.
Overall, 18% of individuals from the ADDITION-Denmark study (n = 27,177) were deemed to have a moderate-to-high risk of diabetes and invited to visit their family physician for assessment of diabetes status and cardiovascular risk (screening group). A follow-up blood test determined that 1533 of these patients had diabetes.
In the current post-hoc analysis, conducted between 2001 and 2009, type 2 diabetes was diagnosed in 13,992 patients in the screening group (including the 1533 patients who had diabetes detected by follow-up blood test) and 125,083 individuals in the no-screening control group.
Using national registry data, researchers quantified the cost of healthcare services in these two groups between 2001 and 2012. “From a healthcare sector perspective, we estimated the potential healthcare cost savings for individuals with diabetes that were attributable to the screening program,” they explain.
Among patients with incident type 2 diabetes, costs for inpatient care, outpatient care, primary care, and prescription drugs were lower by €662 ($814 USD), €82 ($101 USD), €51 ($63 USD), and €94 ($115 USD) per person per year, respectively, among individuals in the screening group.
Total healthcare cost saving was €889 ($1092 USD) per person per year, over an average follow-up of 5 years, for a total of around €4445 over 5 years.
At the same time, cost of the diabetes screening program — including a letter, physician consultation, laboratory tests, and an intensive patient education program (for half of those who screened positive) — was estimated to be €967 ($1186 USD) per participant.
So the screening program was associated with a cost saving per person with incident type 2 diabetes over a 5-year period of €2688 (approximately $3300 USD), Sortsø and colleagues point out.
Patients in the screening program (who were diagnosed earlier in the diabetes disease course than other patients) received earlier diabetes treatment including advice about healthy behaviors, which may explain their fewer hospital admissions or clinic or physician visits, and lower drug costs, the researchers speculate.
The study was funded by the Danish Diabetes Association (Diabetesforeningen). ADDITION-Denmark was supported by the National Health Services in Denmark, Danish Council for Strategic Research, Danish Research Foundation for General Practice, Novo Nordisk Foundation, Danish Centre for Evaluation and Health Technology Assessment, National Board of Health, Danish Medical Research Council, and Aarhus University Research Foundation, and unrestricted grants from Novo Nordisk, ASTRA, Pfizer, GlaxoSmithKline, Servier, and HemoCue. One author was supported by the UK Medical Research Council Epidemiology Unit. The other authors have reported no relevant financial relationships.
Diabetologia. Published online March 16, 2018. Full text
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