Response to comment on Johnson et al. Cost-effectiveness analysis of routine screening using massively parallel sequencing for maturity-onset diabetes of the young in a pediatric diabetes cohort: Reduced health system costs and improved patient quality of life. Diabetes Care 2019;42:69–76

We thank Estrella and Simmons (1) for their letter regarding implications and limitations of our study (2).We agree that most of the cost and health benefits from identifying maturity-onset diabetes of the young (MODY) mutations in children with diabetes is due to conversion from insulin to oral hypoglycemic agents, as discussed in our article. Further, we agree that conversion is not always possible, although, as illustrated in their case, substantial reduction in dose may be possible even if insulin cannot be ceased entirely. As shown in Table 1 and Fig. 2, our sensitivity analysis tested for uncertainty in conversion rates, varying this parameter from 50% to 100% (based on limited published data); routine testing remained beneficial within this range. We agree