Yes, expanding HbA1c testing—especially among younger populations or those with undiagnosed diabetes or prediabetes—could be cost-effective, as early diagnosis and intervention would likely reduce long-term healthcare costs. Here’s how reduced care costs could potentially offset the expense of widespread testing:

Current Costs of Diabetes Care

1. Direct NHS Costs for Diabetes in the UK:

• Diabetes care accounts for 10% of the total NHS budget, approximately £10 billion annually.

• About 80% of these costs are spent on managing complications, such as heart disease, kidney failure, amputations, and vision loss, rather than the condition itself.

2. Cost of Managing Complications:

• Treating complications from undiagnosed or poorly managed diabetes is significantly more expensive than preventive care:

• Dialysis for kidney failure: £30,000–40,000 per patient annually.

• Cardiovascular surgeries: £5,000–15,000 per procedure.

• Amputations and follow-up care: £25,000–50,000 per case.

Potential Cost Savings from Expanded Testing

1. Early Detection Saves Costs:

• Identifying individuals with prediabetes or diabetes early allows for interventions (e.g., lifestyle changes, medications) that delay or prevent complications.

• The cost of managing prediabetes (diet, exercise programs, medications like metformin) is minimal compared to treating advanced diabetes complications.

2. HbA1c Testing Costs vs. Care Costs:

• NHS HbA1c testing cost: ~£14 per test.

• If universal or targeted HbA1c screening could prevent even a small percentage of complications, it would result in substantial savings.

3. Case Studies in Screening Impact:

• A study by Diabetes UK found that early detection of diabetes or prediabetes could save the NHS £5.5 billion over 10 years by reducing hospital admissions and complications.

• Preventing type 2 diabetes in just 1 in 10 high-risk individuals through early detection could yield significant long-term savings.

Cost-Benefit Analysis

1. For Every £1 Spent on HbA1c Testing:

• Return on Investment (ROI): Preventing complications like cardiovascular disease or kidney failure can save thousands per patient, far outweighing the cost of annual or periodic HbA1c testing.

• Example: Screening 1,000 individuals at £14/test (£14,000 total) and identifying even 10 cases of undiagnosed diabetes could prevent complications costing £50,000–100,000.

2. Population-Wide Testing vs. Targeted Testing:

• Universal screening could detect many cases early but may lead to overtesting and higher upfront costs.

• Targeting high-risk groups (e.g., those with obesity, family history, or certain ethnicities) could maximize cost-effectiveness while still capturing most undiagnosed cases.

Broader Benefits

1. Quality of Life:

• Preventing diabetes progression improves patients’ quality of life and reduces the societal burden of disability and early mortality.

2. Reduced Healthcare Strain:

• Early detection reduces emergency admissions, outpatient visits, and long-term care needs, alleviating pressure on the NHS.

3. Workforce Productivity:

• Fewer diabetes-related complications mean less absenteeism and improved productivity among working-age adults.

Conclusion

Investing in widespread or targeted HbA1c testing could be cost-effective, with reduced care costs for diabetes complications potentially paying for the tests many times over. The key is designing a screening program that prioritizes high-risk populations while ensuring accessibility for broader groups.