Cost Effectiveness of Preventive Screening Programmes for Type 2 Diabetes Mellitus in Germany

By Schaufler, Thilo M.; Wolff, Malte | Applied Health Economics and Health Policy, May 2010 | Go to article overview
Save to active project

Cost Effectiveness of Preventive Screening Programmes for Type 2 Diabetes Mellitus in Germany


Schaufler, Thilo M., Wolff, Malte, Applied Health Economics and Health Policy


Background

Germany's statutory health insurance (SHI) expenditure is growing in line with the GDP.[1] However, contribution rates are rising due to a slower growth of assessable income and an increasing share of retired SHI insurants.[2] This is problematic due to the impact of SHI contributions on ancillary wage costs and the labour market, especially the labour-intensive service sector. Consequently, rationalizing and rationing of healthcare services are gaining in importance to limit contribution growth. Prioritization of early detection and prevention of chronic diseases is considered to provide an opportunity for a more effective use of resources and to slow down the growth of SHI contribution rates.[3] However, controversy surrounds the costs and effects in terms of medical and financial outcomes of such programmes.[4]

Several recent studies have assessed the relative cost effectiveness of primary prevention and interventions in type 2 diabetes mellitus (T2DM) based on health economic models. However, none was considered able to fully determine the cost effectiveness of diabetes screening in Germany as was intended with this study. Reasons for this include that existing models have not been fully published with respect to methodology;[5] focused on treatment of patients with known T2DM only;[6-9] included preventive treatment of patients with either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) but neither both groups simultaneously nor the screening programme necessary for identifying these groups;[5,10] or were restricted with regard to the inclusion or projection of all relevant co-morbidities.[7,11-13]

Therefore, we examined the cost effectiveness of screening for T2DM in the setting of the German SHI.

Methods

Screening Programme

The screening strategy that was compared with non-intervention encompassed (i) early detection of pre-diabetes or T2DM by oral glucose tolerance test (OGTT); and (ii) prevention of T2DM in subjects diagnosed with pre-diabetes either by intensive lifestyle intervention as defined by the Diabetes Prevention Program (DPP)[14] or with metformin. Non-intervention refers to diagnosis after the occurrence of the first clinical symptoms without preventive screening, and reflects the status quo of routine clinical practice in Germany. Diagnosis by OGTT is considered the gold standard in detecting pre-diabetes and T2DM. Pre-diabetes is defined as either IFG or IGT as defined by the WHO.[15] Yearly screening is offered to individuals aged 35-75 years covered by the German SHI.

The Model Outline

Due to a lack of data on long-term effects of the proposed screening programme, decision analytic modelling in comparison with the status quo was the method of choice to evaluate efficient allocation of scarce resources. Considering the necessarily long period under review, and parameter uncertainties requiring sensitivity analysis, a Markov model was used to reproduce the time-discrete stochastic process. The major limitation of Markov models (the memoryless feature) was avoided by using decision analytic software (TreeAge Pro Suite 2007) for microsimulation of a cohort of individual potential screening participants. Therefore, transition probabilities in the model also accounted for the individual disease history of each patient.

In contrast to a cohort model, this approach also accounts for the different characteristics of the general German population that would be targeted by the screening programme. While, theoretically, results from microsimulation and cohort models are equivalent if designed correctly, the latter need a much higher number of disease states to allow for the same detailed subgroup analysis. For this reason, cost effectiveness can be predicted more realistically with less effort in a microsimulation. Specifically, this allows us to analyse, for example, differences in disease progression in individuals diagnosed with T2DM in routine clinical care or 'no screening' compared with those diagnosed with pre-diabetes by screening, and either progressing to T2DM or not, and those diagnosed with T2DM by screening.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Cost Effectiveness of Preventive Screening Programmes for Type 2 Diabetes Mellitus in Germany
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?