257: Gestational diabetes screening with the new IADPSG 2 hour glucose tolerance test vs the 1 hour glucose challenge test: a cost-effectiveness analysis

Abstract

2 hour glucose tolerance test vs the 1 hour glucose challenge test: a cost-effectiveness analysis John Mission, Mika Ohno, Keenan Yanit, Yvonne Cheng, Aaron Caughey Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR, Santa Clara Valley Medical Center, Obstetrics and Gynecology, San Jose, CA, Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA OBJECTIVE: The IADPSG recently recommended more inclusive screening criteria for gestational diabetes (GDM) using the 2-hour glucose tolerance test (2hGTT). This study examines the cost-effectiveness of screening with the 2hGTT using these criteria versus the 50g 1-hour glucose challenge test (GCT) with cutoff of 140 mg/dl, accounting for costs and benefits associated with GDM screening, diagnosis, and treatment. STUDY DESIGN: A decision analytic model was built using TreeAge software comparing routine screening using the new 2hGTT vs. the 1-hour GCT. Outcomes included preeclampsia, mode of delivery, maternal death, macrosomia, shoulder dystocia, brachial plexus injury (permanent and transient), hypoglycemia, hyperbilirubinemia, and neonatal death. All costs and benefits were derived from the literature. Less than $100,000 per QALY gained was considered costeffective. Baseline assumptions included a 4% incidence of GDM using the sequential regimen and an additional 15% of patients diagnosed with GDM under the new 2h GTT criteria. One-way sensitivity analyses were used to examine cost-efficacy over a wide range of baseline GDM rates as well as rates of new GDM diagnosis under the new 2h GTT criteria. RESULTS: Screening with the 2h GTT was cost-effective. This strategy was more costly ($2943.33 per patient for the 2h GTT vs $2818.83 per patient for the 1h GCT) but more effective (56.954185 QALYs for the 2h GTT vs 56.951726 for the 1h GCT), with an incremental costeffectiveness ratio of $50,630.34/QALY. In a one-way sensitivity analysis, the more inclusive IADPSG diagnostic approach remained costeffective as long an additional 1.7% or more of patients were diagnosed and treated for GDM. CONCLUSION: Screening at 24-28 weeks GA under the new IADPSG guidelines with the 2h GTT is cost-effective in improving maternal and neonatal outcomes. How the health care system will provide this expanded care to this group of women will need to be examined. 258 Treating patients in HAPO glucose category 5 to improve maternal and neonatal outcomes: a cost effectiveness analysis John Mission, Mika Ohno, Keenan Yanit, Rachel Pilliod, Yvonne Cheng, Aaron B Caughey Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR, Santa Clara Valley Medical Center, Obstetrics and Gynecology, San Jose, CA, Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR, Oregon Health and Science University, Oregon Health and Science University School of Medicine, Portland, OR, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA OBJECTIVE: The HAPO study demonstrated a linear relationship between maternal hyperglycemia and adverse maternal and neonatal outcomes. Subjects were divided into seven categories according to fasting 2-hour glucose tolerance test results. Category 5 included patients between the top 3% and 12% of fasting glucose levels, consistent with marginal patients who would be diagnosed with Gestational Diabetes under the new IADPSG recommendations. This study examines the cost-effectiveness of treating patients in HAPO Category 5 as gestational diabetics, accounting for the costs and benefits associated with the consequences of hyperglycemia in pregnancy. STUDY DESIGN: A decision analytic model was built using TreeAge software that compared treating vs. not treating patients in HAPO Category 5. Outcomes included preeclampsia, mode of delivery, maternal death, macrosomia, shoulder dystocia, brachial plexus injury (permanent and transient), hypoglycemia, hyperbilirubinemia, and neonatal death. All costs and benefits were derived from the literature. Existing randomized controlled trials were used to estimate the effect of treatment on said outcomes. In addition, an index adjusting for treatment efficacy was used for sensitivity analysis. Utilities were applied to discounted life expectancy at a discount rate of 3% to generate Poster Session II Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging www.AJOG.org