OBJECTIVE
Economic analysis of diabetes type 1 screening in children in the Russian Federation.
MATERIAL AND METHODS
We prepared analytical decision-making model in MS Excel to assess the effectiveness and cost of diabetes type 1 screening in children aged 0-18 years with high risk of this disease (first-degree relatives with diabetes type 1). The target population for screening included 156.720 people. We took into account T1DM onset in children and adolescents with diabetic ketoacidosis (DKA) in 80% of cases and possible decrease of the risk of this life-threatening complication following screening by 10 times and hospitalizations in intensive care units by 2 times. We analyzed cost and monetary benefits of screening. We considered direct medical costs including laboratory analysis of 4 autoantibodies and counseling after positive analysis, outpatient follow-up and hospitalizations due to decompensation of disease, re-hospitalizations for various reasons and indirect costs. To analyze direct medical costs of care for type 1 diabetes, DKA and re-hospitalizations, we used cost-effectiveness coefficients for diagnosis-related groups and financial cost standards per a case of medical care. Costs were compared for two scenarios (screening and no screening).
RESULTS
Screening and counseling program reduces the absolute risk of T1DM onset with DKA by 39.9%, DKA-related deaths and re-hospitalizations within a year after DKA for any reason by 2 times. As a result, total costs decrease by 5.5% compared to current practice (no screening) (3.865 and 4.091 billion rubles, respectively). The greatest economic effect is determined by lower mortality and cost of DKA treatment and repeated hospitalizations. Indeed, costs are reduced by 50% in each category. Annual savings per a child who underwent screening are 57.559.37 rubles. In addition, delayed progression of T1DM by 1 year can reduce the cost of insulin therapy for one patient by 20.623.4 rubles per year.
CONCLUSION
Screening of T1DM in children aged 0-18 years will be advisable due to lower number of deaths, hospitalizations and direct costs for the treatment of DKA and subsequent other complications.
