Selecting the optimal risk threshold of diabetes risk scores to identify high-risk individuals for diabetes prevention: a cost-effectiveness analysis.

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  • Additional Information
    • Source:
      Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-5233 (Electronic) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE
    • Publication Information:
      Publication: Berlin : Springer Verlag
      Original Publication: Berlin : Springer International, c1991-
    • Subject Terms:
      Mass Screening*/economics ; Mass Screening*/methods ; Preventive Health Services*/economics ; Preventive Health Services*/methods; Diabetes Mellitus, Type 2/*prevention & control ; Prediabetic State/*diagnosis ; Prediabetic State/*therapy; Adult ; Aged ; Cost-Benefit Analysis ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Humans ; Incidence ; Life Style ; Male ; Middle Aged ; Nutrition Surveys ; Prediabetic State/economics ; Prediabetic State/epidemiology ; Quality-Adjusted Life Years ; Research Design ; Risk Assessment ; Risk Reduction Behavior
    • Abstract:
      Aims: Although risk scores to predict type 2 diabetes exist, cost-effectiveness of risk thresholds to target prevention interventions are unknown. We applied cost-effectiveness analysis to identify optimal thresholds of predicted risk to target a low-cost community-based intervention in the USA.
      Methods: We used a validated Markov-based type 2 diabetes simulation model to evaluate the lifetime cost-effectiveness of alternative thresholds of diabetes risk. Population characteristics for the model were obtained from NHANES 2001-2004 and incidence rates and performance of two noninvasive diabetes risk scores (German diabetes risk score, GDRS, and ARIC 2009 score) were determined in the ARIC and Cardiovascular Health Study (CHS). Incremental cost-effectiveness ratios (ICERs) were calculated for increasing risk score thresholds. Two scenarios were assumed: 1-stage (risk score only) and 2-stage (risk score plus fasting plasma glucose (FPG) test (threshold 100 mg/dl) in the high-risk group).
      Results: In ARIC and CHS combined, the area under the receiver operating characteristic curve for the GDRS and the ARIC 2009 score were 0.691 (0.677-0.704) and 0.720 (0.707-0.732), respectively. The optimal threshold of predicted diabetes risk (ICER < $50,000/QALY gained in case of intervention in those above the threshold) was 7% for the GDRS and 9% for the ARIC 2009 score. In the 2-stage scenario, ICERs for all cutoffs ≥ 5% were below $50,000/QALY gained.
      Conclusions: Intervening in those with ≥ 7% diabetes risk based on the GDRS or ≥ 9% on the ARIC 2009 score would be cost-effective. A risk score threshold ≥ 5% together with elevated FPG would also allow targeting interventions cost-effectively.
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    • Grant Information:
      DZD grant 82DZD00302 German Ministry of Education and Research and the State of Brandenburg
    • Contributed Indexing:
      Keywords: Clinical prediction rule; Cost-effectiveness analysis; Diabetes mellitus, Type 2; Lifestyle risk reduction
    • Publication Date:
      Date Created: 20191121 Date Completed: 20200629 Latest Revision: 20200629
    • Publication Date:
      20221213
    • Accession Number:
      PMC7093341
    • Accession Number:
      10.1007/s00592-019-01451-1
    • Accession Number:
      31745647