TY  - JOUR
A1  - Mühlenbruch, Kristin
A1  - Zhuo, Xiaohui
A1  - Bardenheier, Barbara
A1  - Shao, Hui
A1  - Laxy, Michael
A1  - Icks, Andrea
A1  - Zhang, Ping
A1  - Gregg, Edward W.
A1  - Schulze, Matthias Bernd
T1  - Selecting the optimal risk threshold of diabetes risk scores to identify high-risk individuals for diabetes prevention
BT  - a cost-effectiveness analysis
JF  - Acta Diabetologica
N2  - Aims:
Although risk scores to predict type 2 diabetes exist, cost-effectiveness of risk thresholds to target prevention interventions are unknown. We applied cost-effectiveness analysis to identify optimal thresholds of predicted risk to target a low-cost community-based intervention in the USA. 

Methods:
We used a validated Markov-based type 2 diabetes simulation model to evaluate the lifetime cost-effectiveness of alternative thresholds of diabetes risk. Population characteristics for the model were obtained from NHANES 2001-2004 and incidence rates and performance of two noninvasive diabetes risk scores (German diabetes risk score, GDRS, and ARIC 2009 score) were determined in the ARIC and Cardiovascular Health Study (CHS). Incremental cost-effectiveness ratios (ICERs) were calculated for increasing risk score thresholds. Two scenarios were assumed: 1-stage (risk score only) and 2-stage (risk score plus fasting plasma glucose (FPG) test (threshold 100 mg/dl) in the high-risk group). 

Results:
In ARIC and CHS combined, the area under the receiver operating characteristic curve for the GDRS and the ARIC 2009 score were 0.691 (0.677-0.704) and 0.720 (0.707-0.732), respectively. The optimal threshold of predicted diabetes risk (ICER < $50,000/QALY gained in case of intervention in those above the threshold) was 7% for the GDRS and 9% for the ARIC 2009 score. In the 2-stage scenario, ICERs for all cutoffs >= 5% were below $50,000/QALY gained.

Conclusions:
Intervening in those with >= 7% diabetes risk based on the GDRS or >= 9% on the ARIC 2009 score would be cost-effective. A risk score threshold >= 5% together with elevated FPG would also allow targeting interventions cost-effectively.
KW  - diabetes mellitus
KW  - type 2
KW  - cost-effectiveness analysis
KW  - lifestyle risk reduction
KW  - clinical prediction rule
Y1  - 2019
U6  - https://doi.org/10.1007/s00592-019-01451-1
SN  - 0001-5563
SN  - 0940-5429
SN  - 1432-5233
VL  - 57
IS  - 4
SP  - 447
EP  - 454
PB  - Springer
CY  - Mailand
ER  - 
TY  - JOUR
A1  - Sureth, Michael
A1  - Kalkuhl, Matthias
A1  - Edenhofer, Ottmar
A1  - Rockström, Johan
T1  - A welfare economic approach to planetary boundaries
JF  - Jahrbücher für Nationalökonomie und Statistik
N2  - The crises of both the climate and the biosphere are manifestations of the imbalance between human extractive, and polluting activities and the Earth’s regenerative capacity. Planetary boundaries define limits for biophysical systems and processes that regulate the stability and life support capacity of the Earth system, and thereby also define a safe operating space for humanity on Earth. Budgets associated to planetary boundaries can be understood as global commons: common pool resources that can be utilized within finite limits. Despite the analytical interpretation of planetary boundaries as global commons, the planetary boundaries framework is missing a thorough integration into economic theory. We aim to bridge the gap between welfare economic theory and planetary boundaries as derived in the natural sciences by presenting a unified theory of cost-benefit and cost-effectiveness analysis. Our pragmatic approach aims to overcome shortcomings of the practical applications of CEA and CBA to environmental problems of a planetary scale. To do so, we develop a model framework and explore decision paradigms that give guidance to setting limits on human activities. This conceptual framework is then applied to planetary boundaries. We conclude by using the realized insights to derive a research agenda that builds on the understanding of planetary boundaries as global commons.
KW  - cost-benefit analysis
KW  - cost-effectiveness analysis
KW  - global commons
KW  - planetary boundaries
KW  - precautionary principle
KW  - shadow price
KW  - uncertainty
KW  - welfare economics
Y1  - 2023
U6  - https://doi.org/10.1515/jbnst-2022-0022
SN  - 0021-4027
SN  - 2366-049X
VL  - 243
IS  - 5
SP  - 477
EP  - 542
PB  - De Gruyter Oldenbourg
CY  - Berlin
ER  -