Screening for Gestational Diabetes Mellitus: Are the Criteria Proposed by the International Association of the Diabetes and Pregnancy Study Groups Cost-Effective?
Open Access
- 10 February 2012
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 35 (3), 529-535
- https://doi.org/10.2337/dc11-1643
Abstract
OBJECTIVE: The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recently recommended new criteria for diagnosing gestational diabetes mellitus (GDM). This study was undertaken to determine whether adopting the IADPSG criteria would be cost-effective, compared with the current standard of care. RESEARCH DESIGN AND METHODS: We developed a decision analysis model comparing the cost-utility of three strategies to identify GDM: 1) no screening, 2) current screening practice (1-h 50-g glucose challenge test between 24 and 28 weeks followed by 3-h 100-g glucose tolerance test when indicated), or 3) screening practice proposed by the IADPSG. Assumptions included that 1) women diagnosed with GDM received additional prenatal monitoring, mitigating the risks of preeclampsia, shoulder dystocia, and birth injury; and 2) GDM women had opportunity for intensive postdelivery counseling and behavior modification to reduce future diabetes risks. The primary outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS: Our model demonstrates that the IADPSG recommendations are cost-effective only when postdelivery care reduces diabetes incidence. For every 100,000 women screened, 6,178 quality-adjusted life-years (QALYs) are gained, at a cost of $125,633,826. The ICER for the IADPSG strategy compared with the current standard was $20,336 per QALY gained. When postdelivery care was not accomplished, the IADPSG strategy was no longer cost-effective. These results were robust in sensitivity analyses. CONCLUSIONS: The IADPSG recommendation for glucose screening in pregnancy is cost-effective. The model is most sensitive to the likelihood of preventing future diabetes in patients identified with GDM using postdelivery counseling and intervention.Keywords
This publication has 41 references indexed in Scilit:
- Universal cervical‐length screening to prevent preterm birth: a cost‐effectiveness analysisUltrasound in Obstetrics & Gynecology, 2010
- Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysisBMJ, 2010
- International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in PregnancyDiabetes Care, 2010
- Prevalence of Diabetes and High Risk for Diabetes Using A1C Criteria in the U.S. Population in 1988–2006Diabetes Care, 2010
- 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes StudyThe Lancet, 2009
- A Multicenter, Randomized Trial of Treatment for Mild Gestational DiabetesNew England Journal of Medicine, 2009
- Treatments for gestational diabetesCochrane Database of Systematic Reviews, 2009
- Prevention of Diabetes in Women with a History of Gestational Diabetes: Effects of Metformin and Lifestyle InterventionsJournal of Clinical Endocrinology & Metabolism, 2008
- Costs and consequences of treatment for mild gestational diabetes mellitus – evaluation from the ACHOIS randomised trialBMC Pregnancy and Childbirth, 2007
- Cost-Savings Analysis of an Outpatient Management Program for Women with Pregnancy-Related Hypertensive ConditionsDisease Management, 2006