D iabetes is a major health problem, particularly for the millions of Americans with undiagnosed diabetes, for whom treatment and glycemic control could substantially reduce the onset of complications of this disease. The CDC Diabetes Cost-Effectiveness Group has published a number of articles based on cost-effectiveness analyses (CEA) using a sophisticated Markov simulation model. This probability-based model predicts the onset of diabetes in a hypothetical cohort of patients and follows them as they transition into the various disease states associated with complications and ultimately death. The first analysis (1998) estimates the cost-effectiveness of one-time opportunistic screening (i.e., done during routine contact with a health system). Two cohorts were used in this study, (1) a hypothetical population without diabetes assigned to either opportunistic screening or current clinical practice, and (2) a hypothetical cohort of 10,000 newly diagnosed diabetics who are followed for the development of major complications under the two screening alternatives. The second analysis (2002) estimates the cost- effectiveness of three interventions for the hypothetical cohort of 10,000 newly diagnosed diabetics: (1) asive glycemic control; (2) intensive hypertension control; and (3) reduction in serum cholesterol. ger and colleagues (2004) use the CDC Markov model to estimate the cost-effectiveness of two screening strategies: (1) diabetes screening targeted at those individuals with hypertension and (2) universal diabetes screening. 3 Questions 1. What is the difference between cost-benefit, cost-effectiveness, and cost-utility analysis? 2. What is the relationship between cost and effectiveness? Does more effectiveness always cost more money? 3. When doing CEA it is important to identify the perspective from which the analysis is conducted. In other words, from whose perspective are the costs and benefits recognized? What are the different perspectives? With the diabetes CEA, a single-payer perspective is assumed. What does this mean, and what kinds of costs are ignored? 4. What kinds of costs are usually included in a CEA? The diabetes CEA included screening costs, treatment costs, diabetes intervention costs, and diabetes complication costs. Under what category of costs would screening and treatment fall? 5. Why do we need to get streams of cost over time? 6. What are the costs associated with extending life for those with morbidity? p. 464