Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care

Rodríguez-Pérez, María Cristo; Orozco‐Beltrán, Domingo; Gil-Guillén, Vicente Francisco; Domínguez-Coello, Santiago; Almeida-González, Delia; Brito-Díaz, Buenaventura; Marcelino-Rodríguez, Itahisa; Carratalá-Munuera, M. Concepción; Gómez-Moreno, Nieves; Navarro-Pérez, Jorge; Brotons-Muntó, Francisco; Martínez, Salvador Pertusa; León, Antonio Cabrera de

doi:10.1016/j.diabres.2017.05.009

Cited by 7 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Disease prognosis and patient evolution from pre-symptomatic stages of disease were modeled in most cases to estimate aggregate costs and outcomes. All included studies but 2 (3%) [ 38 , 64 ] explicitly commented on challenges encountered while trying to adequately model disease progression and patient transition through health states. Pre-symptomatic disease refers to the point in progression when the disease is developing but no symptoms are apparent.…”

Section: Resultsmentioning

confidence: 99%

“…According to the WHO, screening interventions are expected to provide treatment alternatives for those patients with identified cases of disease [ 1 ]. However, 15 studies (22%) failed to model a treatment pathway [ 22 – 24 , 26 , 29 , 31 , 38 , 44 , 57 , 64 , 70 – 74 ]. The main outcomes captured by these studies were the following: cases detected, missed cases, avoided cases, and identified true positives and true negatives.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

View full text Add to dashboard Cite

BackgroundScreening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools.ObjectiveThis review seeks to evaluate the latest cost-effectiveness analyses on screening tools to identify the current challenges encountered and potential methods to overcome them.MethodsA systematic literature search of EMBASE and MEDLINE identified cost-effectiveness analyses of screening tools published in 2017. Data extracted included the population, disease, screening tools, comparators, perspective, time horizon, discounting, and outcomes. Challenges and methodological suggestions were narratively synthesized.ResultsFour key categories were identified: screening pathways, pre-symptomatic disease, treatment outcomes, and non-health benefits. Not all studies included treatment outcomes; 15 studies (22%) did not include treatment following diagnosis. Quality-adjusted life years were used by 35 (51.4%) as the main outcome. Studies that undertook a societal perspective did not report non-health benefits and costs consistently. Two important challenges identified were (i) estimating the sojourn time, i.e., the time between when a patient can be identified by screening tests and when they would have been identified due to symptoms, and (ii) estimating the treatment effect and progression rates of patients identified early.ConclusionsTo capture all important costs and outcomes of a screening tool, screening pathways should be modeled including patient treatment. Also, false positive and false negative patients are likely to have important costs and consequences and should be included in the analysis. As these patients are difficult to identify in regular data sources, common treatment patterns should be used to determine how these patients are likely to be treated. It is important that assumptions are clearly indicated and that the consequences of these assumptions are tested in sensitivity analyses, particularly the assumptions of independence of consecutive tests and the level of patient and provider compliance to guidelines and sojourn times. As data is rarely available regarding the progression of undiagnosed patients, extrapolation from diagnosed patients may be necessary.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

View full text Add to dashboard Cite

show abstract

“…Moreover, the DIABSCORE could be managed by the nursing staff or even self-administrated, avoiding the time-consumption by the physicians. When DIABSCORE was tested in a primary care setting it showed a high degree of satisfaction and acceptance by both patients and professionals, finding in two different Spanish populations a high sensitivity and NPV for DIABSCORE ≥100 [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…A risk score for screening of T2D (DIABSCORE) was developed and validated in a general population cohort from Canary Islands [ 11 ]. Also, the DIABSCORE was validated in patients undergoing primary care in 2 regions of Spain, and the results have shown that it is cost-effective and applicable method in screening for T2D [ 12 ]. DIABSCORE reached out, in both genders, a high sensitivity to detect cases of T2D and high capacity to discriminate (NPV), providing a fast and reliable method to reject the presence of diabetes with a high satisfaction of professionals and patients.…”

Section: Introductionmentioning

confidence: 99%

Validation of DIABSCORE in screening for Type 2 Diabetes and prediabetes in Tunisian population

et al. 2018

Self Cite

View full text Add to dashboard Cite

AimsTo perform a validation of DIABSCORE in a sample of Tunisian adults and find out the optimal cut-off point for screening of Type 2 diabetes (T2D) and prediabetes.Methods225 adults 18–75 years and a subgroup of 138 adults (18–54 years), with undiagnosed T2D from the region of Cap-Bon, Tunisia were included in the present study. The DIABSCORE was calculated based on: age, waist/height ratio, family history of T2D and gestational diabetes. Receiver operating characteristics (ROC) curves and areas under curve (AUC) were obtained. The T2D and prediabetes prevalences odds ratios (OR) between patients exposed and not exposed to DIABSCORE≥90 and DIABSCORE≥80, respectively were calculated in both age ranges.ResultsFor screening of T2D the best value was DIABSCORE = 90 with a highest sensitivity (Se), negative predictive value (NPV) and lower negative likelihood ratio in participants aged 18–75 yr (Se = 97%; NPV = 97%) when compared to participants aged 18–54 yr (Se = 95%; NPV = 97%); for prediabetes, the best Se and NPV were for DIABSCORE = 80 in both age groups, but it showed a disbalanced sensitivity-specificity. The ROC curves for T2D showed a similar AUC in both age ranges (AUC = 0.62 and AUC = 0.61 respectively). The ROC curves for prediabetes showed a highest AUC in those aged 18–54 years than the older ones (AUC = 0.62 and AUC = 0.57, respectively). The prevalences OR of T2D for DIABSCORE≥90 was higher than for DIABSCORE≥80 in both age ranges. Nevertheless, the prevalences OR of prediabetes for DIABSCORE≥90 was half of the detected for DIABSCORE≥80 in both age ranges.ConclusionThe DIABSCORE is a simple clinical tool and accurate method in screening for T2D and prediabetes in the adult Tunisian population.

show abstract

“…Although many studies have discovered more precise cut-off values for WHtR in their particular populations, several have suggested that the simple value of 0.5 is perfectly adequate for this public health policy message: "Keep your waist to less than half your height" [32][33][34]. Not only has WHtR been promoted as a primary screening tool in its own right [35] but it has been used as the anthropometric proxy within more complex opportunistic screening tools such as DIABSCORE [36]. In 2015, the New Zealand (NZ) Ministry of Health was the first Government department to publish weight management guidance including WHtR as one available measure.…”

Section: Step1: Central Obesity Is Harmfulmentioning

confidence: 99%

How long is A Piece of String? Less than Half your Height. Five Steps from Science to Screening: A Mini Review

Ashwell¹

2017

AOWMC

View full text Add to dashboard Cite

Central obesity is harmful in terms of cardiometabolic risk, but it can only be measured accurately with expensive equipment. The aim of this review is to summarise how the scientific evidence has accumulated to the extent that waist-to-height ratio (WHtR), which has been shown to be a simple proxy for central obesity, is starting to be adopted into public health policy and can now be used as a simple, early screening tool. A boundary value of WHtR 0.5 has been suggested as the first level of risk. This translates into the simple message "Keep your waist to less than half your height". However, to check if WHtR is less than 0.5 does not even need a tape measure. A piece of string will suffice. The string is used to measure the person's height and then it is folded in half to see whether it fits easily around the person's waist. If it does not, early health risk is indicated and further screening is indicated. Thus the string acts as a simple, cheap, signposting tool for early health risk. At long last we have the answer to that age old question: "How long is piece of string?" The answer is "Less than half a person's height if we want to improve public health through opportunistic screening."

show abstract

Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care

Cited by 7 publications

References 16 publications

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Validation of DIABSCORE in screening for Type 2 Diabetes and prediabetes in Tunisian population

How long is A Piece of String? Less than Half your Height. Five Steps from Science to Screening: A Mini Review

Contact Info

Product

Resources

About