Potential cost-effectiveness of childhood screening for type 1 diabetes: Examining reducing Diabetic Ketoacidosis at diagnosis and long-term outcomes to assess the justifiable cost per child screened. [version 1; peer review: awaiting peer review]

Introduction

Diabetic ketoacidosis (DKA) life-threatening emergency that occurs in 38% of children with newly diagnosed type 1 diabetes (T1D) in England and Wales. We conducted a cost-utility analysis to assess the potential cost-effectiveness of a childhood T1D screening program for children aged 4 years in England and Wales compared with no screening to reduce the incidence of DKA at T1D diagnosis.

Methods

We developed a decision tree economic model that included the probability of having T1D, the probability that each child with T1D had DKA at diagnosis, and long-term costs and quality-adjusted life years (QALYs) using general population norms and an adapted version of the Sheffield T1D policy model that did not model the incidence of diabetes-related complications in children aged under 18 years. We tested a screening program that reduced the incidence of DKA at the time of diagnosis by 80%. We calculated the cost of a screening program to provide an incremental cost-effectiveness ratio of £20,000 per QALY gained compared to no screening. We conducted several scenario analyses to test the effects of different data sources and the additional benefits of screening for children with T1D.

Results

For a screening program that reduced DKA by 80%, we showed that the maximum that could be spent on testing and follow-up for children with positive results is £3.17 per child screened. If preventing DKA at diagnosis also improved long-term glycemic control (modelled as a reduction in glycated hemoglobin (HbA1c) of 0.5% (5 mmol/mol)), the maximum could be spent to £23.29 - £56.74, depending on how long improved glycemic control was maintained.

Conclusions

A general population screening program for T1D that only reduces the risk of DKA at diagnosis is unlikely to be economically feasible unless DKA reduction or screening has long-term benefits, such as delaying T1D or persistently lowering HbA1c.