Abstract
ObjectiveTimely screening for hyperglycaemia in pregnancy using a simple glucose test enhances early detection and control of gestational diabetes mellitus (GDM). The aim of this study was to provide an overview of the evidence on the cost-effectiveness of identification and/or treatment of GDM.MethodsWe conducted a systematic review using three electronic databases (PubMed, EMBASE, and Cochrane) of cost-effectiveness studies of GDM screening and treatment published during 2000–2017.ResultsThe initial search discovered 287 references (PubMed 86, EMBASE 195, Cochrane library 6) of which six full articles were included in the review. Two articles were model-based analysis and the remaining four were trial based. Two studies demonstrated favorable cost-effectiveness of intensified management of mild GDM. In the other included studies, neither screening nor treatment of GDM was shown to be cost effective, although results varied with the particular outcome measures used and the assumptions that where applied.ConclusionNeither screening nor treating GDM seems to be convincingly cost-effective from the studies reviewed. However, all studies were done in high-income countries with obviously different health systems than low-/middle-income countries (LMIC) have. Since detection of GDM may be relatively poor in LMIC, screening might be more worthwhile in these countries. Comprehensive research is necessary in LMIC, including the potential outcomes of assessing its cost-effectiveness. Favorable cost-effectiveness could help in bridging the need for and access to increased diabetes screening in early pregnancy in these countries.
Highlights
An increased blood glucose level (92–125 mg/dl) first detected at any time during pregnancy is classified as gestational diabetes mellitus (GDM) as part of hyperglycemia in pregnancy (HIP), which is any kind of increased blood glucose level during pregnancy, including live births in women with known diabetes [1]
The objective of the present study is to provide, by means of a literature review, an overview of the existing evidence on the cost-effectiveness of identification and/or treatment of GDM
We conducted a literature review of cost-effectiveness studies related to gestational diabetes mellitus published between 2000 and 2017, taking into account reporting guidelines of preferred reporting items for systematic reviews and metaanalyses (PRISMA) diagram [25]
Summary
An increased blood glucose level (92–125 mg/dl) first detected at any time during pregnancy is classified as gestational diabetes mellitus (GDM) as part of hyperglycemia in pregnancy (HIP), which is any kind of increased blood glucose level during pregnancy, including live births in women with known diabetes [1]. The distinction between HIP and GDM has only recently (2013) been made by the World Health Organization (WHO) [2]. The International Diabetes Federation (IDF) estimates that 21.4 million (16.8%) of women who gave live birth in 2013 had some form of HIP. The Southeast Asian Region had the highest crude incidence of the HIP at 23.1% of live births, followed closely by the Middle East and North African Region with 22.3% [3].
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