American Diabetes Association
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Costs of Public Health Screening of Children for Presymptomatic Type 1 Diabetes in Bavaria, Germany

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posted on 2022-02-14, 14:26 authored by Florian M. Karl, Christiane Winkler, Anette-Gabriele Ziegler, Michael Laxy, Peter Achenbach
Objective: Evaluation of costs associated with public health screening for presymptomatic type 1 diabetes in 90,632 children as part of the Fr1da study in Bavaria and in forecasts for standard care.

Research Design and Methods: We report on resource utilization and direct costs for screening-related procedures in the Fr1da study coordination center and laboratory, and in participating pediatric practices and local diabetes clinics. Data was obtained from Fr1da study documents, an online survey among pediatricians, and interviews and records of Fr1da staff members. Data were analyzed with tree models that mimic procedures during the screening process. Cost estimates are presented as they were observed in the Fr1da study and as they can be expected in standard care for various scenarios.

Results: The costs per child screened in the Fr1da study were €28.17 (95% CI: 19.96; 39.63) and the costs per case diagnosed with presymptomatic type 1 diabetes were €9,117 (6,460; 12,827). Assuming a prevalence of presymptomatic type 1 diabetes of 0.31%, as in the Fr1da study, the estimated costs in standard care in Germany would be €21.73 (16.76; 28.19) per screened child and €7,035 (5,426; 9,124) per diagnosed child. Of the projected screening costs, €12.25 would be the costs in the medical practice, €9.34 for coordination and laboratory, and €0.14 for local diabetes clinics.

Conclusions: This study provides information for the planning and implementation of screening tests for presymptomatic type 1 diabetes in the general public and for the analysis of the cost-effectiveness of targeted prevention strategies.


This study was supported by grants from the German Federal Ministry of Education and Research to the German Center for Diabetes Research (DZD e.V.). The Fr1da study was supported by grants from the LifeScience-Stiftung (HMGU 2014.01 and HMGU 2016.01), Juvenile Diabetes Research Foundation International (1-SRA-2014-310-M-R and 3-SRA-2015-72-M-R), the Bavarian State Ministry of Health and Care (Gesund.Leben.Bayern, LP00228), The Leona M and Harry B Helmsley Charitable Trust (G-1911-03274), Deutsche Diabetes-Stiftung (364/11/14), Landesverband Bayern der Betriebskrankenkassen, B. Braun-Stiftung (BBST-D-15-00016), Deutsche Diabetes Hilfe, and the German Federal Ministry of Education and Research to the German Center for Diabetes Research (DZD e.V.).


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