ArticleActa diabetologica2020
Selecting the optimal risk threshold of diabetes risk scores to identify high-risk individuals for diabetes prevention: a cost-effectiveness analysis.
Article in Acta diabetologica, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Risk stratification in diabetic kidney disease: a review of prediction models for methodological advances and clinical application.Journal of translational medicine · 2026Review
- Statins for primary prevention of cardiovascular disease in Germany: benefits and costs.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Risk prediction models for macrovascular complications in type 2 diabetes mellitus: from traditional risk scores to multimodal intelligent prediction.Frontiers in endocrinology · 2026Review
- Risk of new-onset diabetes and efficacy of pharmacological weight loss therapy.Diabetes, obesity & metabolism · 2024Article
- Precision prognostics for the development of complications in diabetes.Diabetologia · 2022Review
- German Diabetes Risk Score for the Determination of the Individual Type 2 Diabetes Risk—10-Year Prediction and External Validations.Deutsches Arzteblatt international · 2022Article
- Targeting of the diabetes prevention program leads to substantial benefits when capacity is constrained.Acta diabetologica · 2021Article
- Agreement between Type 2 Diabetes Risk Scales in a Caucasian Population: A Systematic Review and Report.Journal of clinical medicine · 2020Article
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Authors and funding
9 authors.
Funding
Abstract
aimsAlthough risk scores to predict type 2 diabetes exist, cost-effectiveness of risk thresholds to target prevention interventions are unknown. We applied cost-effectiveness analysis to identify optimal thresholds of predicted risk to target a low-cost community-based intervention in the USA.
methodsWe used a validated Markov-based type 2 diabetes simulation model to evaluate the lifetime cost-effectiveness of alternative thresholds of diabetes risk. Population characteristics for the model were obtained from NHANES 2001-2004 and incidence rates and performance of two noninvasive diabetes risk scores (German diabetes risk score, GDRS, and ARIC 2009 score) were determined in the ARIC and Cardiovascular Health Study (CHS). Incremental cost-effectiveness ratios (ICERs) were calculated for increasing risk score thresholds. Two scenarios were assumed: 1-stage (risk score only) and 2-stage (risk score plus fasting plasma glucose (FPG) test (threshold 100 mg/dl) in the high-risk group).
resultsIn ARIC and CHS combined, the area under the receiver operating characteristic curve for the GDRS and the ARIC 2009 score were 0.691 (0.677-0.704) and 0.720 (0.707-0.732), respectively. The optimal threshold of predicted diabetes risk (ICER < $50,000/QALY gained in case of intervention in those above the threshold) was 7% for the GDRS and 9% for the ARIC 2009 score. In the 2-stage scenario, ICERs for all cutoffs ≥ 5% were below $50,000/QALY gained.
conclusionsIntervening in those with ≥ 7% diabetes risk based on the GDRS or ≥ 9% on the ARIC 2009 score would be cost-effective. A risk score threshold ≥ 5% together with elevated FPG would also allow targeting interventions cost-effectively.
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