Everyone or Just Some? Cost-Effectiveness of General Population Versus Targeted Screening Strategies for Type 1 Diabetes in Canada

OBJECTIVE: Timely screening for type 1 diabetes can prevent life-threatening diabetic ketoacidosis and offers the opportunity to delay disease onset with emerging disease-modifying therapies. Yet, population-wide screening is costly, raising questions on whether its benefits justify the costs and the optimal age and frequency of screening. This study examined the cost-effectiveness of general population versus targeted autoantibody screening at alternative ages and frequencies. RESEARCH DESIGN AND METHODS: Using a hybrid decision tree-Markov model, this study compared six strategies defined by different populations screened (i.e., general population vs. only groups at high genetic risk or those with a family history), and frequency and age of screening (once at age 4 vs. twice, at ages 2 and 6) versus no screening. Costs were estimated from the Canadian health system perspective, and effectiveness was measured as the number of at-risk children detected. RESULTS: Compared with family history-based screening at ages 2 and 6, general population screening at age 4 cost $404,534 more but detected 35 more cases (per 10,000 children) for an incremental cost-effectiveness ratio of $11,383/case detected. General population screening at ages 2 and 6 cost an additional $462,679 and detected 18 more cases (per 10,000 children) at an incremental cost of $25,923/case detected. Screening targeted at only infants at high genetic risk involved higher costs and detected fewer cases than general population screening. CONCLUSIONS: General population screening detects more at-risk children than targeted approaches but also incurs higher costs. The incremental cost per case detected is comparable to that reported for other pediatric screening initiatives.