Acta Diabetol

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\u20132004 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\ua0mg/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\u20130.704) and 0.720 (0.707\u20130.732), respectively. The optimal threshold of predicted diabetes risk (ICER\u2009<\u2009$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\u2009 65\u20095% were below $50,000/QALY gained.ConclusionsIntervening in those with\u2009 65\u20097% diabetes risk based on the GDRS or\u2009 65\u20099% on the ARIC 2009 score would be cost-effective. A risk score threshold\u2009 65\u20095% together with elevated FPG would also allow targeting interventions cost-effectively.Electronic supplementary materialThe online version of this article (10.1007/s00592-019-01451-1) contains supplementary material, which is available to authorized users.DZD grant 82DZD00302/German Ministry of Education and Research and the State of Brandenburg/2019-11-19T00:00:00Z31745647PMC7093341865