Lifetime Cost-Effectiveness of Using the Chinese Diabetes Risk Score for Prediabetes Screening in China

To more comprehensively evaluate the lifetime cost-effectiveness of different prediabetes screening strategies based on the Chinese Diabetes Risk Score (CDRS) from a societal perspective and to explore the impact of different CDRS cutoff values on the evaluation.

A Markov model encompassing the complete natural history of type 2 diabetes was developed to compare costs, cumulative prevalence of type 2 diabetes complications, mortality rates, and quality-adjusted life years of 3 screening strategies: (1) the control group, the current screening strategy; (2) strategy 1, CDRS screening for all adults; and (3) strategy 2, supplemental CDRS screening for adults without annual health checkups. It was assumed that the individual exited the model upon reaching 80 years old or death in the model. The robustness of results was assessed through sensitivity analyses.

Compared with the control group and strategy 2, strategy 1 saved $583.07 and $233.12 per capita, respectively, reduced the cumulative prevalence of type 2 diabetes complications by 8.47% and 1.64%, respectively, reduced mortality rates by 1.47% and 0.25%, respectively, and increased quality-adjusted life years by 0.07 and 0.01 per capita, respectively. At the cutoff value of 24, strategy 1 achieved the lowest cost and the highest health benefits.

Compared with the control group and strategy 2, strategy 1-implementing prediabetes screening in all adults via CDRS-was absolutely dominant when modeling the complete natural history of diabetes. The CDRS screening strategies demonstrated better cost-effectiveness when the cutoff value was set at 24.