264: Cost-effectiveness analysis of screening for GDM

Abstract

Treatment of gestational diabetes mellitus (GDM) reduces the risk of perinatal and maternal complications associated with GDM, but data on the effectiveness of treatment have not been integrated with data on the accuracy of screening for GDM. The aim of this study was to assess the cost-effectiveness of screening for GDM. We developed a decision model to evaluate costs and effects of six screening strategies for GDM at several moments during pregnancy: random glucose measurement, fasting glucose measurement, 50 g glucose challenge test, risk factor assessment, risk factor assessment combined with a 50 g glucose challenge test (all followed by an oral glucose tolerance test (OGTT) if indicated) and universal screening with an OGTT. Costs and effects of the screening strategies were compared to a strategy without testing. Data on costs, accuracy measures and probabilities were extracted from the literature. The outcome measure of effect was a composite outcome of neonatal death, shoulderdystocia, and birth trauma. We calculated the costs to prevent one serious neonatal complication. Analyses were performed from the perspective of the healthcare system. All screening strategies reduced the risk of serious perinatal complications. At 24 weeks of pregnancy the most effective strategy was screening all women with an OGTT, however at the highest costs. Use of risk factor assessment combined with a 50 g glucose challenge test, and subsequent OGTT if indicated was the most cost-effective strategy. The incremental cost-effectiveness ratio ranged from ϵ23, 479 per prevented neonatal complication with risk factor assessment combined with the 50 g glucose challenge test to ϵ37, 037 per prevented neonatal complication for use of the 50 g glucose challenge test in all women. Screening for GDM with risk factor assessment combined with a 50 g glucose challenge test and an OGTT if indicated is the most cost-effective strategy.