The cost-effectiveness of screening for gestational diabetes mellitus in primary and secondary care in the Republic of Ireland

Abstract

Aims/hypothesis The aim of the study was to assess the cost-effectiveness of screening for gestational diabetes mellitus (GDM) in primary and secondary care settings, compared with a no-screening option, in the Republic of Ireland. Methods The analysis was based on a decision-tree model of alternative screening strategies in primary and secondary care settings. It synthesised data generated from a randomised controlled trial (screening uptake) and from the literature. Costs included those relating to GDM screening and treatment, and the care of adverse outcomes. Effects were assessed in terms of quality-adjusted life years (QALYs). The impact of the parameter uncertainty was assessed in a range of sensitivity analyses. Results Screening in either setting was found to be superior to no screening, i.e. it provided for QALY gains and cost savings. Screening in secondary care was found to be superior to screening in primary care, providing for modest QALY gains of 0.0006 and a saving of €21.43 per screened case. The conclusion held with high certainty across the range of ceiling ratios from zero to €100,000 per QALY and across a plausible range of input parameters. Conclusions/interpretation The results of this study demonstrate that implementation of universal screening is cost-effective. This is an argument in favour of introducing a properly designed and funded national programme of screening for GDM, although affordability remains to be assessed. In the current environment, screening for GDM in secondary care settings appears to be the better solution in consideration of costeffectiveness.

Maternal and fetal outcome of comparative study between old & adopted new value of screening of Gestational Diabetes Mellitus in tertiary centre in Saudi Arabia

“…The method was also cost effective. This type of universal screening was supported in earlier studies by [11] (in the year 2000) and recently by [12] and [13] etc.…”

Exploring Structural Uncertainty in Cost-Effectiveness Modeling of Gestational Diabetes Screening: An Application Example from Norway

“…The base-case probabilities among women with normal glucose tolerance were informed by pooling estimates from 3 European cohort or registry studies. [29][30][31][32] Due to a lack of literature values, we used the proportion of women with perineal trauma (sphincter rupture grades 3 and 4) from the Medical Birth Registry in our model, despite potential distortion by cases of undetected GDM and potential underreporting. 33 We multiplied the base-case probabilities first with the RR of adverse pregnancy outcomes associated with GDM, then with the RR rates associated with GDM treatment, as reported by the USPSTF systematic review from the year 2021.…”

Early diabetes screening in pregnancy

“…Several studies have assessed the cost‐effectiveness of screening modalities for diabetes in pregnancy, mostly focusing on the currently accepted OGTT . Some have tried to assess the use of alternative modalities such as FPG for screening, circumventing the OGTT .…”

“…Even after establishing that early screening for gestational diabetes is possible, and after ascertaining the best screen- Several studies have assessed the cost-effectiveness of screening modalities for diabetes in pregnancy, mostly focusing on the currently accepted OGTT. 53,54 Some have tried to assess the use of alternative modalities such as FPG for screening, circumventing the OGTT. 55 In an attempt to assess the effect of early screening on the prevalence and outcome of GDM, early screening (before 24 weeks of pregnancy) via OGTT, FPG, or HbA1c testing was compared with an OGTT at 24-28 weeks.…”