PDB14 - Gestational Diabetes Screening for Chinese Women: A Cost-Effectiveness Analysis

Abstract

The prevalence of gestational diabetes (GDM) is growing in China, and it is associated with a boosted risk of complications for the mother and neonate, such as pre-eclampsia, intrauterine death, stillbirth, post-partum type 2 diabetes, and macrosomia. GDM is also related with birth trauma, hypoglycemia, hyperbilirubinemia, respiratory distress, long-term obesity and childhood diabetes. Early determination and treatment of GDM can significantly diminish the incidence of these complications. The diagnostic criteria for GDM, however, remain questionable whether it is cost-effective or not. The objective of this study is to investigate the cost effectiveness of new American Diabetes Association (ADA) guideline on GDM screening in China. A decision analytic model was built to compare new GDM criteria (ADA 2011) and old criteria in China. All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed. Screening with the 75g-OGTT was more expensive and effective. In a 1-way sensitivity analysis, the ADA 2011 diagnostic approach remained cost-effective even triple of patients were diagnosed and treated for gestational diabetes mellitus. ADA 2011 diagnostic approach, however, was no longer cost-effective when long-term maternal and neonatal outcomes were not considered. Screening at 24-28 weeks’ gestational age under the ADA 2011 guidelines with the 2h OGTT is expensive but cost effective in improving long-term maternal and neonatal outcomes.