Screening Adults for Type 2 Diabetes: A Cost-effectiveness Analysis. Table 5. Sensitivity Analyses

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Table 5. Sensitivity Analyses

Sensitivity Analysis Scenario	Cost-effectiveness Ratio ($/QALY)
Sensitivity Analysis Scenario	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 time^a 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 time^a	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

^a Sensitivity 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.

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