OBJECTIVES: To analyze the cost-effectiveness of one-time diabetes screening at age of 30 in India compared to no screening, and the budget impact, from the Indian societal perspective. METHODS: We created a Markov model comparing cost and utility of one-time screening of persons at age 30 against current practice, which is diagnosis when patients become symptomatic or present with complications of diabetes. The modeling was done from the Indian societal perspective. The cycle length was set at one year, and the model run for 43 cycles, the calculated Indian life expectancy at age 30. The costs were drawn from studies done in India, and were inflation-adjusted to 2016 INR (Indian Rupee) values. Health utility, measured in units of Quality-adjusted Life Years (QALYs), were drawn from population surveys, and the rates of progression to impaired glucose tolerance and type 2 diabetes were taken from longitudinal studies in non-Asian populations; all other clinical and epidemiological parameters were obtained from Asian Indian populations. The extended model added repeat screening every five years, and sensitivity analyses were done on utilities (beta distribution) and costs (gamma distributions). Budget impact analysis was done for a coverage of 80% achieved over 3-5 years. RESULTS: One-time screening at age 30 (160,537 INR, 20.36 QALYs) is dominant compared to current practice (208,717 INR, 20.01 QALYs) at an incremental cost-effectiveness ratio of 132,839 INR /QALY, with probabilistic estimates showing dominance in all of the 10,000 simulations. Additional screening every five years is also dominant over current practice in all PSA simulations. The budget impact of one-time screening would be 24 billion INR, 0.4% of Indian public healthcare expenditure. CONCLUSIONS: Population based one-time screening at age 30 in India is cost-effective. Additional research should be done on how this might be implemented so as to strengthen existing primary and secondary care.