Table 3. Universal Screening with Intensive Glycemic Control and Intensive Hypertension Control after Diagnosis

Illustrative Case in the Model Age at Diagnosis, y Results per True Diabetes Case Results per Person Eligible for Screening Cost/QALY ($)
Lifetime Cumulative Incidence (%) Life-Yearsa QALYsb Lifetime Costs ($)a Life-Years Gaineda QALYs Gainedb
ESRD LEA Blind Stroke CHD Screen & Diagnostic Testing Diab. Treatment Diab. Intervention Diab. Complications Total
Screen at 35 y   (onset at 30 y)
W/o screening 40 24.28 41.05 12.89 12.41 26.87 34.05 20.08 0 794 897 2,677 4,369      
W/ screening 35 23.53 41.03 12.96 12.50 27.01 34.16 20.13 25 952 1,103 2,620 4,700      
Screening effect   -0.75 -0.02 0.07 0.09 0.14 0.12 0.05 25 158 206 -58 331 0.007 0.003 126,238
Screen at 45 y   (onset at 40 y)
W/o screening 50 14.54 28.36 9.18 14.25 31.05 26.92 17.26 0 639 742 1,882 3,263      
W/ screening 45 13.99 28.32 9.25 14.34 30.91 27.02 17.32 25 800 957 1,844 3,627      
Screening effect   -0.55 -0.04 0.07 0.09 -0.14 0.10 0.05 25 162 214 -38 364 0.005 0.003 121,965
Screen at 55 y   (onset at 50 y)
W/o screening 60 6.25 14.89 5.23 14.47 32.76 18.96 13.32 0 633 687 1,552 2,872      
W/ screening 55 6.02 14.96 5.31 14.65 31.61 19.14 13.43 25 830 966 1,529 3,351      
Screening effect   -0.23 0.07 0.08 0.18 -1.15 0.18 0.11 25 197 279 -23 479 0.012 0.008 62,934
Screen at 65 y   (onset at 60 y)
W/o screening 70 1.74 5.91 2.47 14.83 30.95 12.33 9.40 0 167 185 453 805      
W/ screening 65 1.67 5.94 2.53 15.05 29.38 12.50 9.51 23 239 295 449 1,007      
Screening effect   -0.07 0.03 0.06 0.22 -1.57 0.16 0.11 23 72 110 -4 202 0.005 0.003 59,183
Screen at 75 y   (onset at 70 y)
W/o screening 80 0.21 1.59 0.81 14.06 25.12 7.11 5.82 0 53 54 175 282      
W/ screening 75 0.20 1.59 0.84 14.32 23.05 7.26 5.94 8 84 107 175 374      
Screening effect   -0.01 0.00 0.03 0.26 -2.07 0.15 0.11 8 31 53 0 92 0.003 0.002 48,146

aUndiscounted.

bDiscounted at 3%.

Note: Screening effects for cumulative incidence are expressed as percentage points. CHD = Coronary heart disease events; Diab. = Diabetes; ESRD = End-stage renal disease; LEA = Lower-extremity amputation; QALY = Quality-adjusted life year.

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