Screening For Diabetes Potentially Cost-Effective For UK

Main Category: Diabetes
Article Date: 15 May 2008 - 4:00 PDT

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A new University of Leicester study reveals that screening people who are at risk of developing diabetes could be a cost-effective health policy and improve the lives of patients.

Their study, funded jointly by the Economic and Social Research Council (ESRC) and the Medical Research Council (MRC) as part of an interdisciplinary research initiative in the social and medical sciences, was published in the British Medical Journal as an online first article on bmj.com

The study found that screening people at risk, for either impaired glucose tolerance (a precursor for diabetes) or Type 2 diabetes mellitus, and applying interventions to delay progression to diabetes or providing early treatment of diabetes, was potentially a cost-effective policy for the UK when compared to a strategy of no screening.

Professor Keith Abrams, Professor Kamlesh Khunti and Ms Clare Gillies, of the Department of Health Sciences at the University of Leicester, led the research which they said was timely in view of the recent announcement by the Department of Health for a vascular risk screening programme.

Professor Abrams said: "This work highlights the potential benefits of the introduction of a screening policy to identify individuals with impaired glucose tolerance and type 2 diabetes mellitus in the UK."

1. Researchers at the University of Leicester compared the cost and health implications of four different approaches to screening for impaired glucose tolerance and type 2 diabetes. These were:

i. no screening
ii. screening for type 2 diabetes alone resulting in health benefits from early diagnosis and treatment of the disease
iii. screening for impaired glucose tolerance and type 2 diabetes, allowing for both early treatment of diabetes and for lifestyle interventions to be applied to individuals with impaired glucose tolerance to reduce their risk of developing diabetes
iv. as for iii) but with pharmacological rather than lifestyle interventions

2. A computer decision model was developed using data from a number of sources to evaluate the cost and health implications of these four policies. The model simulated a population with an increased risk of developing type 2 diabetes, who were 45 years of age at the start of the model and thus time of screening. The model was run to estimate the cost and health implications over a 50 year time horizon, and the four different screening policies were then compared.

3. Estimated costs for each quality adjusted life year gained were £14,150 for screening for type 2 diabetes alone, £6,242 for screening for diabetes and impaired glucose tolerance followed by lifestyle interventions, and £7,023 for screening for diabetes and impaired glucose tolerance followed by pharmacological interventions, all compared with no screening. At the current threshold used by the National Institute for Health and Clinical Excellence (NICE) of £20,000 per quality adjusted life year gained, the probabilities that these three active screening strategies are cost-effective compared to no screening are 49%, 93% and 85% respectively.

4. Screening for type 2 diabetes and impaired glucose tolerance, with appropriate intervention for those with impaired glucose tolerance, in an above average risk population aged 45, therefore appears to be cost effective. The cost effectiveness of a policy of screening for diabetes alone, which offered no intervention to those with impaired glucose tolerance, is still uncertain and more information is needed on the long term health implications of early diagnosis and treatment of this disease.

The Economic and Social Research Council (ESRC) is the UK's largest funding agency for research and postgraduate training relating to social and economic issues. It supports independent, high quality research which impacts on business, the public sector and the third sector. The ESRC's planned total expenditure in 2008/09 is £203 million. At any one time the ESRC supports over 4,000 researchers and postgraduate students in academic institutions and research policy institutes. More at http://www.esrcsocietytoday.ac.uk

The Medical Research Council supports the best scientific research to improve human health. Its work ranges from molecular level science to public health medicine and has led to pioneering discoveries in our understanding of the human body and the diseases which affect us all.

University Of Leicester

A member of the 1994 Group of universities that share a commitment to research excellence, high quality teaching and an outstanding student experience.

- Ranked top for student satisfaction in England (jointly with Oxford) among mainstream universities (average score of 4.4 out of 5 for overall satisfaction)

- Ranked as a Top 20 university by The Sunday Times University Guide, The Guardian University Guide and the UK Good University Guide

- One of just 23 UK universities to feature in world's top 200- Shanghai Jiao Tong International Index, 2005-07.

- Ranked in top 200 world universities by the THES (Times Higher Education Supplement)

- Short listed University of the Year in 2007 by The Sunday Times and Short listed Higher Education Institution of the Year - THES awards 2005 and 2006

- Ranked top 10 in England for research impact by The Guardian

- Students' Union of the Year award 2005, short listed 2006 and 2007

Founded in 1921, the University of Leicester has 19,000 students from 136 countries. Teaching in 18 subject areas has been graded Excellent by the Quality Assurance Agency- including 14 successive scores - a consistent run of success matched by just one other UK University. Leicester is world renowned for the invention of DNA Fingerprinting by Professor Sir Alec Jeffreys and houses Europe's biggest academic Space Research Centre. 90% of staff are actively engaged in high quality research and 13 subject areas have been awarded the highest rating of 5* and 5 for research quality, demonstrating excellence at an international level. The University's research grant income places it among the top 20 UK research universities. The University employs over 3,000 people, has an annual turnover of £184m, covers an estate of 94 hectares and is engaged in a £300m investment programme- among the biggest of any UK university.

University Of Leicester