Cost-effectiveness of diabetes screening in patients with psychotic disorders in a model and preliminary results of implementation of screening in psychiatric care

Background: The prevalence of diabetes and other somatic co-morbidity is higher in patients with psychotic disorders than in the general population. Annual screening can detect diabetes early to prevent the progression of diabetes, prevent complications and improve the quality of life. This improvement can only be made if the screening leads to treatment of that patient. Aims of the Study: We determined the cost-effectiveness of somatic screening for diabetes in patients with psychotic disorders in a model. In a sample of outpatients the cost and benefits of screening and coordination of care are estimated. Methods: In the model costs were determined for the screening and treatment of detected diabetes cases. The savings and QALY weights due to prevention or postponement of complications was calculated by the model of the CDC Diabetes Cost-Effectiveness Study group. The cost per quality of life adjusted year (QALY) were determined. We compared in a group of psychiatric outpatients the difference between only screening on somatic comorbidity with screening and coordination of care based on screening results. Effects were measured in identified health needs and percentage met needs, costs were estimated based on health care consumption. Results: The cost for screening were €140.79 per patient. Based on literature data it was assumed that diabetes was detected five years earlier than without screening. Treatment cost for diabetes were €2483.60 for five years. Cost savings of €9629.60 and a gain of 0.24 QALY could be achieved through delay of complications for five years. Cost per QALY gained were below €20 000, the threshold generally used in The Netherlands, at an incidence of 1.2% in patients with psychotic disorders with an average age of 38 years. Preliminary results of the implementation of screening will be available March 2011. Conlcusion and Discussion: The screening of patients with psychotic disorders for diabetes is cost-effective. Indirect costs and savings were not included because of the large rate of unemployment in this patient group. The results on the intervention are preliminary results after a pilot study. Implications for Health Care Provision and Use: Annual screening for diabetes in patients with psychotic disorders should be implied in health care programs for patients with psychotic disorders, the way in which in should be implemented is not yet clear. Implications for Further Research: Further research should assess if the model of the CDC is valid for this population. Furthermore research should assess the implementation of preventive health services, like diabetes screening, in psychiatric care facilities.