Economic evaluation of potential national childhood screening strategies for type 1 diabetes in Australia
Year: 2025
Type: article
Abstract: Background: Type 1 diabetes (T1D) is an autoimmune condition affecting children. We aimed to investigate the costs and cost-effectiveness of potential national childhood screening strategies for T1D compared to no screening (usual care). Methods: Screening costs were obtained from trial-based estimates. A Markov microsimulation model was developed to identify the most cost-effective childhood T1D screening strategy. The three screening strategies modelled were: Strategy 1) newborn genetic risk-stratification with bloodspot sampling, followed by autoantibody screening in at-risk children; Strategy 2) infant genetic risk-stratification using saliva sampling, followed by autoantibody screening in at-risk children; Strategy 3) population-wide autoantibody screening at two childhood ages. The model tracked 100,000 individuals from birth to 30 years of age. One-way and probabilistic sensitivity analyses were conducted. Findings: Newborn bloodspot genetic risk-stratified screening (strategy 1) was the most cost-effective strategy. Incremental cost-effectiveness ratios (ICERs) were $50,682 per quality-adjusted life year (QALY) gained for strategy 1, $85,440 per QALY gained for strategy 2, and $133,285 per QALY gained for strategy 3. In the optimal strategy (strategy 1), the cost was $480,798 per screen-detected T1D and $12,183 per episode of diabetic ketoacidosis avoided. Results were sensitive to changes in time horizon, discount rates, and cost of the screening tests. Interpretation: Of the three modelled T1D screening strategies, newborn bloodspot genetic risk-stratified screening was the most cost-effective. Varying cost inputs may change this hierarchy. Our economic evaluation will be useful for informing future T1D childhood screening policy in Australia and other high-income countries. Funding: JDRF Australia.
Authors: Winnie Chen, Winnie Chen, Kirsten Howard, Kirsten Howard, Sarah Norris, Sarah Norris, Natasha Nassar, Natasha Nassar, Maria E. Craig, Maria E. Craig, Kirstine J. Bell, Kirstine J. Bell, Kirstine J. Bell, Kirstine J. Bell, Maria E. Craig, Maria E. Craig, Peter G. Colman, Jennifer J. Couper, Elizabeth A. Davis, Gary Deed, Adrienne Gordon, Christel Hendrieckx, Amanda Henry, Tony Huynh, Natasha Nassar, Natasha Nassar, Antonia Shand, Richard O. Sinnott, Jane Speight, John M. Wentworth, William Hagopian, Aveni Haynes, Kirsten Howard, Kirsten Howard, Sarah Norris, Sarah Norris, Richard Oram, Shannon Brodie, William Hu, Kara Mikler, Bethany Wadling, Fleur Kelly, Bernadette Kerr, Courtney Weston, Winnie Chen, Winnie Chen
Language: English
Subfield: Genetics
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,250
OpenAlex ID: W4417183463