| Sensitivity Analysis Scenario | Cost-effectiveness Ratio ($/QALY) | |
|---|---|---|
| Targeted vs No Screening | Universal vs Targeted Screening | |
| Base-case analysis Incremental cost of tight hypertension control, $149 Screening test cost, $24.40 Diagnostic test cost, $8.32 People identified with diabetes receive intensive glycemic control 5 y detection benefit from screening Screening sensitivity based on >8 h postprandial timea Intensive hypertension control results in a 51% relative risk reduction for CHD Intensive hypertension control has no effects on relative risk for stroke Diabetes prevalence = mean prevalence reported in NHANES III |
34,375 | 360,966 |
| Incremental cost of tight hypertension control, $300 | 37,153 | 362,079 |
| Screening, diagnostic test costs doubled Screening test cost, $48.80 Diagnostic test cost, $16.64 |
35,783 | 384,503 |
| People identified with diabetes receive standard glycemic control | 17,472 | 164,850 |
| No extra cost for intensive glycemic control for persons screened with diabetes during first 5 y of treatment | 14,497 | 190,454 |
| 2-y detection benefit from screening | 35,875 | 308,525 |
| 8-y detection benefit from screening | 33,850 | 474,121 |
| Screening sensitivity, specificity based on <8 hrs postprandial timea | 34,551 | 364,465 |
| Intensive hypertension control results in a 25% relative risk reduction for CHD | 68,448 | 411,623 |
| Intensive hypertension control results in a 30% relative risk reduction for stroke | 28,122 | 352,186 |
| Diabetes prevalence (mean - 1 standard deviation) reported prevalence in NHANES III | 34,696 | 367,371 |
| Diabetes prevalence (mean + 1 standard deviation) reported prevalence in NHANES III | 34,157 | 356,866 |
aSensitivity and specificity of capillary blood glucose test screening is based on test results < 120 mg/dL and both >8 and <8 hours postprandial time based on CBG as reported in Figure 2 of Rolka 2001.22
Note: All incremental cost-effectiveness ratios are calculated for persons age 50 years at diabetes onset and 55 years at screening. CHD = coronary heart disease events; NHANES III = National Health and Nutrition Examination Survey III; QALY = Quality adjusted life-year.