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

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.