Screening for Type 2 Diabetes Mellitus: A Systematic Review of Recent Economic Evaluations

Abstract

Objectives

To examine recent economic evaluations and understand whether any type 2 diabetes mellitus (T2DM) screening designs may represent better value for money and to rate their methodological qualities.

Methods

We systematically searched 3 concepts (economic evaluations [EEs], T2DM, screening) in 5 databases (Medline, Embase, EconLit, Web of Science, and Cochrane) for EEs published between 2010 and 2023. Two independent reviewers screened for and rated their methodological quality (using the Consensus on Health Economics Criteria Checklist-Extended).

Results

Of 32 EEs, a majority were from high-income countries (69%). Half used single biomarkers (50%) to screen adults ≥30 to <60 years old (60%) but did not report locations (69%), treatments for those diagnosed (66%), diagnostic methods (57%), or screening intervals (54%). Compared with no screening, T2DM screening using single biomarkers was found to be not cost-effective (23/54 comparisons), inconclusive (16/54), dominant (11/54), or cost-effective (4/54). Compared with no screening, screening with a risk score and single biomarkers was found to be cost-effective (21/40) or dominant (19/40). The risk score alone was mostly dominant (6/10). Compared with universal screening, targeted screening among obese, overweight, or older people may be cost-effective or dominant. Compared with fasting plasma glucose or fasting capillary glucose, screening using risk scores was found to be mostly dominant or cost-effective. Expanding screening locations or lowering HbA1c or fasting plasma glucose thresholds was found to be dominant or cost-effective. Each EE had 4 to 17 items (median 13/20) on Consensus on Health Economics Criteria Checklist-Extended rated “Yes/Rather Yes.”

Conclusions

EE findings varied based on screening tools, intervals, locations, minimum screening age, diagnostic methods, and treatment. Future EEs should more comprehensively report screening designs and evaluate T2DM screening in low-income countries.