Healthcare costs associated with gestational diabetes mellitus during pregnancy and potential cost-effectiveness of prevention in high-risk women

Abstract

Background: Gestational Diabetes Mellitus (GDM) affects 14% of pregnancies in Australia and is associated with an increased risk of pregnancy complications and developing type 2 diabetes. Methods: A modelled micro-costing study to estimate the excess healthcare utilisation and costs associated to GDM was undertaken. Clinical guidelines and expert opinion of endocrinologists and obstetricians were utilised to describe the clinical pathway associated to GDM surveillance and management during pregnancy. National epidemiological data was utilised to estimate GDM-attributable complication rates. National cost weights were attached to all healthcare resources. Estimated GDM healthcare costs were used to inform a cost-effectiveness analysis of GDM prevention. Data were sourced from a recent Australian RCT in 228 women at increased GDM risk which found that a behavioural lifestyle intervention significantly reduced excess gestational weight gain and a trend for lower GDM incidence in the intervention group. Results: Healthcare costs attributable to GDM were estimated to be ≈AUD3200 per patient during pregnancy and the early neonatal period. One third of these costs related to GDM surveillance and management which are relatively fixed costs contingent upon a GDM diagnosis and designation of a pregnancy as high-risk. The remaining costs related to obstetric and neonatal complications attributable to GDM. GDM prevention cost-effectiveness results are forthcoming. Conclusions: The GDM cost estimated in this study can be utilised to inform GDM economic evaluations. Our study suggests that, from a financial perspective, spending AUD3200 to prevent one case of GDM would be cost-neutral based on pregnancy and neonatal costs. For GDM prevention, existing engagement in antenatal care provides an opportunity to target high-risk women. Furthermore, pregnancy is a time of significant motivation for women around healthy behaviours. These attributes of the antenatal setting, combined with increasing evidence that GDM is preventable, make economic evaluation of GDM interventions a priority.