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

<i>Objective: </i>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. <p><i>Research Design and Methods</i>: 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. </p> <p><i>Results</i>: 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. </p> <p><i>Conclusions</i>: 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.</p>