Age at initiation and frequency of screening to detect diabete II
A cost-effectiveness analysis
Original Text - The Lancet, Early Online Publication, 30 March 2010 [Abstract]
Dr Richard Kahn PhD a Corresponding AuthorEmail Address, Peter Alperin MD b, David Eddy MD b, Knut Borch-Johnsen MD c, John Buse MD d, Justin Feigelman b, Edward Gregg PhD e, Rury R Holman MD f, M Sue Kirkman MD a, Michael Stern MD g, Jaakko Tuomilehto MD h, Prof Nick J Wareham i

L’American Diabetes Association (ADA) recommande de dépister le diabète de type 2 chez tous les sujets en surpoids ou ayant un ou plusieurs autres facteurs de risque de diabète. En outre l’ADA préconise, même en l’absence de ces facteurs, de procéder à un dépistage systématique à partir de 45 ans, en le renouvelant tous les 3 ans. Ce dépistage, selon l’ADA, doit être couplé à celui de l’hypertension et des troubles lipidiques. NB 1 : En pratique nous avons tous la glycémie "facile". L'avenir = HbA1C ? [Lire] NB 2 : Cela correspond peu ou prou au dépistage du syndrome métabolique, non ? [Lire] NB 3 : Une étude randomisée simulée sur ordinateur aussi bien pour l'échantillon que pour les stratégies. Peut-on se fier au virtuel pour décider ? ([jim.fr] NB 4 : Funding : Novo Nordisk, Bayer Pharmaceuticals, and Pfizer.... euhhhhhh

Background : No clinical trials have assessed the effects or cost-effectiveness of sequential screening strategies to detect new cases of type 2 diabetes. We used a mathematical model to estimate the cost-effectiveness of several screening strategies.

Methods : We used person-specific data from a representative sample of the US population to create a simulated population of 325 000 people aged 30 years without diabetes. We used the Archimedes model to compare eight simulated screening strategies for type 2 diabetes with a no-screening control strategy. Strategies differed in terms of age at initiation and frequency of screening. Once diagnosed, diabetes treatment was simulated in a standard manner. We calculated the effects of each strategy on the incidence of type 2 diabetes, myocardial infarction, stroke, and microvascular complications in addition to quality of life, costs, and cost per quality-adjusted life-year (QALY).

Findings : Compared with no screening, all simulated screening strategies reduced the incidence of myocardial infarction (3—9 events prevented per 1000 people screened) and diabetes-related microvascular complications (3—9 events prevented per 1000 people), and increased the number of QALYs (93—194 undiscounted QALYs) added over 50 years. Most strategies prevented a significant number of simulated deaths (2—5 events per 1000 people). There was little or no effect of screening on incidence of stroke (0—1 event prevented per 1000 people). Five screening strategies had costs per QALY of about US$10 500 or less, whereas costs were much higher for screening started at 45 years of age and repeated every year ($15 509), screening started at 60 years of age and repeated every 3 years ($25 738), or a maximum screening strategy (screening started at 30 years of age and repeated every 6 months; $40 778). Several strategies differed substantially in the number of QALYs gained. Costs per QALY were sensitive to the disutility assigned to the state of having diabetes diagnosed with or without symptoms.

Interpretation : In the US population, screening for type 2 diabetes is cost effective when started between the ages of 30 years and 45 years, with screening repeated every 3—5 years.

Funding : Novo Nordisk, Bayer Pharmaceuticals, and Pfizer.

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