Immunization to prevent insulin-dependent diabetes mellitus? The economics of genetic screening and vaccination for diabetes

Abstract

There is increasing evidence that some cases of insulin-dependent diabetes mellitus are virally induced, and vaccination against this disease may become possible. We have prospectively examined the costs and benefits that would occur if a diabetes vaccine were developed, using a decision tree to model the alternative vaccination policies, including histocompatibility leukocyte antigen (HLA) screening. We found many cost and likelihood data in the literature, and when data on the potential vaccine had to be hypothesized, we used sensitivity analysis to check our estimates. We conclude that vaccinating all children at age 3 would be preferable to HLA screening and vaccinating only persons with a genetic predisposition to developing diabetes. A 50% effective vaccine would cut the diabetes incidence rate by 29% and save the U.S. population $30 million annually in direct costs of diabetes care. If indirect costs are considered these savings could amount to $4.2 billion over 60 years, discounted to present value at 5%, while preventing over 200,000 cases of insulin-dependent diabetes.