Optimal Prediabetes HbA1c Threshold is 5.7 Percent

Lowering the HbA1c level to 5.7 percent is cost effective, even when intervention costs are high

THURSDAY, March 22 (HealthDay News) -- Lowering the glycated hemoglobin (HbA1c) cut-off threshold for prediabetes to 5.7 percent is cost-effective even in a high-cost intervention scenario, according to research published online March 13 in the American Journal of Preventive Medicine.

Xiaohui Zhuo, Ph.D., of the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues used data from the National Health and Nutritional Examination Survey to construct a Markov simulation model designed to evaluate the cost-effectiveness associated with reducing the HbA1c cut-off from 6.4 to 5.5 percent for identifying prediabetes in adults. Two different scenarios were modeled, a high-cost intervention and a low-cost intervention.

The researchers suggest that reducing the cut-off would increase the health benefits at an increased cost. In the high-cost intervention scenario, incrementally reducing the prediabetes cut-off by 0.1 percent, beginning at an HbA1c level of 6.0 percent and going down to 5.5 percent, resulted in a cost of $27,000 (5.9 percent), $34,000 (5.8 percent), $45,000 (5.7 percent), $58,000 (5.6 percent), and $96,000 (5.5 percent), respectively, per quality-adjusted life-year (QALY) gained. For the low-cost intervention, the corresponding results per QALY gained were $24,000 (5.9 percent), $27,000 (5.8 percent), $34,000 (5.7 percent), $43,000 (5.6 percent), and $70,000 (5.5 percent). Using a standard cost-effectiveness benchmark of $50,000/QALY, the optimal HbA1c cut-off was 5.7 percent.

"Lowering the cut-off from 5.7 percent to 5.6 percent or even lower also might be cost-effective, if the costs of preventive interventions could be reduced," the authors write.

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