ASK_Technical_Appendix_Revision_Clean.docx (284.21 kB)

Cost and Cost-Effectiveness of Large Scale Screening for Type 1 Diabetes in Colorado

Download (284.21 kB)
figure
posted on 23.04.2020 by R. Brett McQueen, Cristy Geno, Kathleen Waugh, Brigitte I. Frohnert, Andrea K. Steck, Liping Yu, Judith Baxter, Marian Rewers
Objective: To assess the costs and project the potential lifetime cost-effectiveness of the ongoing Autoimmunity Screening for Kids (ASK) Program, a large-scale pre-symptomatic type 1 diabetes screening program for children and adolescents in the metro Denver region.

Research Design and Methods: We report the resource utilization, costs, and effectiveness measures from the ongoing ASK program as compared to usual care (i.e., no screening). Additionally, we report a practical screening scenario by including utilization and costs relevant to routine screening in clinical practice. Finally, we project the potential cost-effectiveness of ASK and routine screening by identifying clinical benchmarks (i.e., DKA events avoided, HbA1c improvements vs. no screening) needed to meet value thresholds of $50,000 to $150,000 per quality-adjusted life year (QALY) gained over a lifetime horizon.

Results: Cost per case detected was $4,700 for ASK screening and $14,000 for routine screening. To achieve value thresholds of $50,000 to $150,000 per QALY gained, screening costs would need to be offset by cost savings through 20% reductions in DKA events at diagnosis in addition to 0.1% (1.1 mmol/mol) improvements in HbA1c over a lifetime as compared to no screening for patients that develop type 1 diabetes. Value thresholds were not met from avoiding DKA events alone in either scenario.

Conclusions: Pre-symptomatic type 1 diabetes screening may be cost-effective in areas with high prevalence of DKA and infrastructure facilitating screening and monitoring if the benefits of avoiding DKA events and improved HbA1c persist over long-run time horizons. As more data are collected from ASK, the model will be updated with direct evidence on screening effects.

Funding

The ASK Study (3-SRA-2018-564-M-N) is funded by JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, and Janssen Research and Development, LLC.

History

Exports

Logo branding

Exports