BACKGROUND: Personalized medicine requires diagnostic tests that stratify patients into distinct groups that may differentially benefit from targeted treatment approaches. This study compared the costs and benefits of two approaches for identifying those at high risk of developing type 2 diabetes for entry into a diabetes prevention program. The first approach identified high risk patients using impaired fasting glucose (IFG). The second approach used the PreDx Diabetes Risk Score (DRS) to further stratify IFG patients into high-risk and moderate-risk groups. METHODS: A Markov model was developed to simulate the incidence and disease progression of diabetes and consequent costs and quality-adjusted life expectancy (QALY), comparing alternative approaches for identifying high-risk patients. We modeled direct medical costs, including the costs of the stratification testing, over a 10-year time horizon from a US payer perspective. RESULTS: Stratification of IFG patients by the DRS method leads to improved identification and prevention among those at highest risk. At 5 years, the number needed to treat (NNT) in the IFG-only approach was 39 patients to prevent one case of diabetes compared to an NNT of 15 in the IFG + DRS approach. When compared to IFG alone, the IFG + DRS approach results in an incremental cost-effectiveness ratio (ICER) of $17,100/QALY gained at 5 years and would become cost saving in 10 years. In contrast and as compared to no stratification, the IFG-only approach would produce an ICER of $235,500/QALY gained at 5 years and $94,600/QALY gained at 10 years. The study findings are limited by the generalizability of the DRS validation study and uncertainty regarding the long-term effectiveness of diabetes prevention. CONCLUSIONS: The analysis indicates that the cost-effectiveness of diabetes prevention can be improved by better identification of patients at highest risk for diabetes using the DRS.
BACKGROUND: Personalized medicine requires diagnostic tests that stratify patients into distinct groups that may differentially benefit from targeted treatment approaches. This study compared the costs and benefits of two approaches for identifying those at high risk of developing type 2 diabetes for entry into a diabetes prevention program. The first approach identified high risk patients using impaired fasting glucose (IFG). The second approach used the PreDx Diabetes Risk Score (DRS) to further stratify IFG patients into high-risk and moderate-risk groups. METHODS: A Markov model was developed to simulate the incidence and disease progression of diabetes and consequent costs and quality-adjusted life expectancy (QALY), comparing alternative approaches for identifying high-risk patients. We modeled direct medical costs, including the costs of the stratification testing, over a 10-year time horizon from a US payer perspective. RESULTS: Stratification of IFG patients by the DRS method leads to improved identification and prevention among those at highest risk. At 5 years, the number needed to treat (NNT) in the IFG-only approach was 39 patients to prevent one case of diabetes compared to an NNT of 15 in the IFG + DRS approach. When compared to IFG alone, the IFG + DRS approach results in an incremental cost-effectiveness ratio (ICER) of $17,100/QALY gained at 5 years and would become cost saving in 10 years. In contrast and as compared to no stratification, the IFG-only approach would produce an ICER of $235,500/QALY gained at 5 years and $94,600/QALY gained at 10 years. The study findings are limited by the generalizability of the DRS validation study and uncertainty regarding the long-term effectiveness of diabetes prevention. CONCLUSIONS: The analysis indicates that the cost-effectiveness of diabetes prevention can be improved by better identification of patients at highest risk for diabetes using the DRS.
Authors: Natalia Olchanski; David van Klaveren; Joshua T Cohen; John B Wong; Robin Ruthazer; David M Kent Journal: Acta Diabetol Date: 2021-01-30 Impact factor: 4.280
Authors: Aldin Malkoc; David Probst; Chi Lin; Mukund Khanwalker; Connor Beck; Curtiss B Cook; Jeffrey T La Belle Journal: J Diabetes Sci Technol Date: 2017-03-16
Authors: Manju Mamtani; Hemant Kulkarni; Gerard Wong; Jacquelyn M Weir; Christopher K Barlow; Thomas D Dyer; Laura Almasy; Michael C Mahaney; Anthony G Comuzzie; David C Glahn; Dianna J Magliano; Paul Zimmet; Jonathan Shaw; Sarah Williams-Blangero; Ravindranath Duggirala; John Blangero; Peter J Meikle; Joanne E Curran Journal: Lipids Health Dis Date: 2016-04-04 Impact factor: 3.876
Authors: Kristin Mühlenbruch; Xiaohui Zhuo; Barbara Bardenheier; Hui Shao; Michael Laxy; Andrea Icks; Ping Zhang; Edward W Gregg; Matthias B Schulze Journal: Acta Diabetol Date: 2019-11-19 Impact factor: 4.280