Abstract
BackgroundThis study aims to find evidence of the cost-effectiveness of gestational diabetes mellitus (GDM) screening and assess the quality of current economic evaluations, which have shown different conclusions with a variation in screening methods, data sources, outcome indicators, and implementation in diverse organizational contexts.MethodsEmbase, Medline, Web of Science, Health Technology Assessment, database, and National Health Service Economic Evaluation Database databases were searched through June 2019. Studies on economic evaluation reporting both cost and health outcomes of GDM screening programs in English language were selected, and the quality of the studies was assessed using Drummond’s checklist. The general characteristics, main assumptions, and results of the economic evaluations were summarized.ResultsOur search yielded 10 eligible economic evaluations with different screening strategies compared in different settings and perspectives. The selected papers scored 81% (68–97%) on the items in Drummond’s checklist on average. In general, a screening program is cost-effective or even dominant over no screening. The one-step screening, with more cases detected, is more likely to be cost-effective than the two-step screening. Universal screening is more likely to be cost-effective than screening targeting the high-risk population. Parameters affecting cost-effectiveness include: diagnosis criteria, epidemiological characteristics of the population, efficacy of screening and treatment, and costs.ConclusionsMost studies found GDM screening to be cost-effective, though uncertainties remain due to many factors. The quality assessment identified weaknesses in the economic evaluations in terms of integrating existing data, measuring costs and consequences, analyzing perspectives, and adjusting for uncertainties.
Highlights
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy
We excluded 93 duplicated studies and 480 articles that did not discuss gestational diabetes mellitus (GDM) screening during pregnancy or only covered cost estimates or effectiveness
Chen PY et al, 2016, Singapore universal vs targeted: $10,630= quality-adjusted life years (QALYs) gained; targeted vs no screening: $9,019= QALY gained subgroup 1-Way 2-way yes no no no yes yes no yes yes
Summary
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM has become an important public health issue and is responsible for increased risks of maternal, prenatal, and neonatal complications, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease in mothers and obesity and long-term metabolic syndrome in their offspring, potentially increasing the economic burden of healthcare. Monitoring and prevention of T2DM in women with prior GDM in the postnatal period is important in reducing the long-term disease burden. This study aims to find evidence of the cost-effectiveness of gestational diabetes mellitus (GDM) screening and assess the quality of current economic evaluations, which have shown different conclusions with a variation in screening methods, data sources, outcome indicators, and implementation in diverse organizational contexts
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