Cost-Effectiveness of T1D Screening Effectiveness in Canadian Children
T1D screening effectiveness in the general population substantially outperforms targeted approaches based on family history or genetic risk, according to a new Canadian health economic analysis. General population autoantibody screening detects far more at-risk children than family-history or genetic strategies, but at significantly higher cost.
Cost Trade-offs Across Screening Strategies
Using a hybrid decision tree-Markov model from the Canadian health system perspective, screening the general population once at age 4 costs an additional $11,383 per additional at-risk case detected compared with family history-based screening at ages 2 and 6. Screening twice, at ages 2 and 6, further increases costs by $25,923 per additional case detected relative to single screening at age 4. Targeted genetic risk-based screening of high-risk infants proved dominated, resulting in both higher total costs and fewer cases detected than general population strategies. These findings highlight a clear trade-off between broader reach and increased expenditure in T1D risk identification.
Detection Impact and DKA Prevention
In a modeled cohort of 10,000 newborns, general population screening at age 4 detected 56 at-risk cases and prevented five diabetic ketoacidosis (DKA) cases at disease onset. This compares with only 16–21 cases detected and one to three DKA cases prevented under family history-based screening. Expanding to two screens raised detection to 74 cases but at markedly higher cost. In contrast, screening only infants in the top quartile of a genetic risk score detected just 20–26 cases while generating screening and monitoring costs exceeding C$2 million per 10,000 children.
Modeling Framework and Key Assumptions
The analysis employed a hybrid decision tree-Markov model to evaluate seven strategies against no screening, incorporating Canadian health system costs in 2024 Canadian dollars discounted at 1.5%. Key inputs included a 1% lifetime risk of autoantibody development in the general population, 94% sensitivity and 96% specificity for the 3-Screen Islet Cell ELISA assay, and an 89% reduction in DKA risk among screened and monitored children.
Value Comparison with Established Pediatric Screening Programs
The incremental costs per additional case detected of $11,383 for single general population screening at age 4 and $25,923 for twice screening compare favorably with cost-effectiveness estimates reported for newborn screening programs for cystic fibrosis and other pediatric conditions in Canada.
Implications for Policy and Future Therapies
These results carry direct implications for evaluating screening program implementation or the future value proposition of disease-modifying therapies such as teplizumab. Because the current model captures only short-term case detection and DKA avoidance, the economic case for population screening is likely to strengthen once long-term quality-of-life gains and the full impact of immunomodulatory treatments are included.
Decision makers should weigh the equity benefits of universal approaches, which avoid reliance on family history that may vary by socioeconomic and ethnic background, against the budget impact of scaling screening infrastructure.
This research provides an evidence-based framework for balancing reach, cost, and clinical benefit in the design of early T1D detection policy in Canada. As Canadian researchers evaluate real-world data from initiatives such as CanScreen T1D, periodic re-evaluation of these strategies will help refine decisions for both screening programs and preventive therapies.
T1D screening effectiveness therefore presents a compelling yet resource-intensive option that warrants careful consideration within Canada’s pediatric screening landscape.
