Presentation (CTI)

OBJECTIVES: To describe the methodological design of an SROI analysis quantifying the multidimensional social impact of a population-based presymptomatic type 1 diabetes (T1D) screening program in the pediatric population in Spain.
METHODS: The analysis followed the six-stage Social Value International SROI framework. Investment was quantified via microcosting of a proposed integrated care pathway (ICP), encompassing autoantibody testing (ELISA), confirmatory testing, metabolic follow-up visits, therapeutic education and psychological support. Four sensitivity scenarios were modeled, varying sample collection method and result communication modality. A pre-validated probabilistic Markov chain model, calibrated on T1D natural progression across presymptomatic stages (Stages 1-2) and clinical onset (Stage 3), was adapted to the Spanish epidemiological context to simulate cohort trajectories and transition probabilities. Social returns were categorized as: (1) clinical: diabetic ketoacidosis (DKA) reduction, acute kidney injury, cerebral edema mortality and metabolic control improvements; (2) psychosocial: informal care costs, parental labor productivity, psychological burden and social stigmatization, monetized via financial proxies; (3) negative: anxiety from presymptomatic diagnosis. Evidence was drawn from official Spanish sources (official tariffs, Ministry of Health, statistics public databases) and published literature for validation by the study team.
RESULTS: The framework systematically identifies the key drivers of both investment and social return, disaggregating contributions by stakeholder and domain. Beyond DKA reduction and clinical outcomes, it surfaces impacts routinely invisible in health economic evaluations: caregiver burden, parental productivity losses, psychological distress, and social stigmatization. The multi-scenario design further reveals how operational choices shape the investment-to-return balance, enabling evidence-informed, context-sensitive program design.
CONCLUSIONS: This integrated SROI framework captures social value, particularly psychosocial impacts on patients, families and caregivers, beyond conventional cost-effectiveness analysis. It provides a transparent, replicable, multi-stakeholder tool to support evidence-based policy decisions on presymptomatic T1D screening implementation within Spain’s NHS.