| Screening for Gestational Diabetes Mellitus: Are the Criteria Proposed by the International Association of Diabetes and Pregnancy Study Groups Cost-Effective? | |
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MedLine Citation:
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PMID: 22266735 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVEThe International Association of Diabetes and Pregnancy Study Group (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 METHODSWe 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).RESULTSOur 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.CONCLUSIONSThe 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. |
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Authors:
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Erika F Werner; Christian M Pettker; Lisa Zuckerwise; Michael Reel; Edmund F Funai; Janice Henderson; Stephen F Thung |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-20 |
Journal Detail:
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Title: Diabetes care Volume: - ISSN: 1935-5548 ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-1-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7805975 Medline TA: Diabetes Care Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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