[Cost of insulin-dependent diabetes vs cost of its prevention]

Accumulating evidence suggests that insulin-dependent diabetes mellitus (IDDM) is an autoimmune disease which can be predicted from immunologic markers. Encouraging results of recent IDDM prevention trials with insulin raises the question of cost benefit of such procedures, in addition to the obvious medical benefit. We estimated the expected cost benefit of national screening and preventive efforts in Israel (population 5 million in 1993). Due to the expense of immunological testing, we considered only relatives of IDDM patients who have a 3-5% risk of developing overt disease. Our screening showed that 225 (3.4%) of 7500 in this group (aged 1-54 years) carried islet autoantibodies, and about 50% progressed to diabetes within 3 years. The cost of testing for serological and metabolic markers was $6000 per subject; an additional $3,000 per subject is estimated to be the cost of preventive treatment. On comparing these numbers to only the minimal, life-long, direct cost of an IDDM patient ($30,000, based on 3 different analyses), we conclude that there is a cost benefit of programs for screening for IDDM and preventive treatment.