Economic evaluations of screening in pre-symptomatic type 1 diabetes (T1D): a systematic literature review

Background: T1D is an autoimmune disorder that destroys insulin-producing pancreatic beta cells. T1D requires intense self-management, balancing long-term insulin use, dietary/exercise variations, and other factors.

Symptomatic T1D is foreshadowed by positivity for multiple autoantibodies and subsequent dysglycemia.

Screening programs being developed by the EDENT1FI (European action for the Diagnosis of Early Non-clinical Type 1 diabetes For disease Interception) consortium aim to identify individuals with early-stage T1D, reduce the
frequency of diabetic ketoacidosis at diagnosis and support a smooth transition to insulin treatment. Policymakers will require evidence of cost-effectiveness before adopting such programs routinely.

Aim: To review the published economic evaluations in pre-symptomatic screening for T1D.

Methods: A search strategy was conducted in electronic databases (Embase, PubMed, Cochrane, EconLit, and CRD database) in November 2023 with no date/language restrictions. Studies reporting cost-effectiveness and those reporting health utility, cost and/or resource use outcomes were reviewed.
Results: After duplicate references were removed from the 1,994 retrieved records, 1,591 (titles/abstracts) were selected for manual screening, 13 of which were included in this review. Three economic evaluations were identified: two assessed cost-effectiveness of screening/post-screening interventions in a pediatric population, and one provided background information on predicting event outcomes using claims data. None of these cost effectiveness studies considered screening in a European healthcare context. Nine studies concerned costs and/or resource use outcomes, including program and breakeven screening costs. Although the information on screening costs may help inform a de novo model to evaluate the economic value of T1D screening, evidence gaps remain on resource use and productivity. Only one study reported utility outcomes based on a valuation exercise of health states where a post-screening intervention may delay T1D.

Conclusions: This review’s findings indicated limited availability of economic evaluations of pre-symptomatic T1D screening. Only a few studies reported parameter values critical for evaluating screening programs, such as health-state utilities, costs, and resource use. Additional primary research would help inform parameter values used in economic evaluations in pre-symptomatic screening programs, particularly in the European context.