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

OBJECTIVES: To categorise screening designs in economic evaluations (EEs) of type 2 diabetes mellitus (T2DM) screening, to examine whether any screening designs may represent better value for money, and to rate their methodological qualities.

METHODS: We systematically searched three databases for EEs published between 2010 and 2023. Two independent reviewers screened and rated the methodological quality of included EEs. Besides study characteristics and study designs, we also extracted screening designs (screening tools i.e., biomarkers / risk scores, screening intervals, screening locations, minimum age eligible for screening, diagnosis methods, and treatment for those diagnosed).

RESULTS: Of 27 EEs, a majority were from high-income countries (70%), performed both cost-utility and cost-effectiveness analyses (81%) and were from health systems perspective (67%) over a lifetime horizon (63%). Most used single biomarkers (52%) to screen adults ≥30-<60 years old (59%) but did not report screening intervals (59%), locations (78%), diagnosis methods (70%) or treatment for those diagnosed (63%). Compared to no screening, T2DM screening using single biomarkers was found mostly not cost-effective (23/51 comparisons) or inconclusive (13/51); single biomarkers in combination with risk score dominant (21/40) or cost-effective (19/40); risk score alone mostly dominant (6/10). Compared to universal screening, targeted screening among obese, overweight, or older people may be cost-effective or dominant. Compared to fasting plasma glucose (FPG) or fasting capillary glucose, screening using risk scores were found mostly dominant or cost-effective. Expanding screening location or lowering HbA1c or FPG thresholds were found dominant or cost-effective. Each EE had 4–17 items on the CHEC-Extended checklist rated “Yes / Rather Yes”. None of the EEs reported all aspects of screening designs.

CONCLUSIONS: EE findings for T2DM screening differed according to screening designs and the comparators. Besides addressing gaps in methodological quality, our systematic review suggests future EEs should more comprehensively report screening designs and examine T2DM screening in low-income countries.