Efficacy and cost of postpartum screening strategies for diabetes among women with histories of gestational diabetes mellitus.
OBJECTIVE
To compare the cost and time to diagnosis associated with several screening strategies for diabetes in women with histories of gestational diabetes mellitus (GDM).


METHODS
We simulated screening for diabetes with fasting plasma glucose (FPG), a 2-h oral glucose tolerance test (OGTT), and A1C annually, every 2 years, and every 3 years over a period of 12 years. We assumed that women had negative screening tests 6 weeks after delivery, progressed to diabetes at 8% per year, and that each positive FPG and A1C was followed by a confirmatory FPG. For each strategy, we calculated the cost per case detected, cost per woman screened, the percent of cases detected, and the time elapsed with undiagnosed diabetes. In sensitivity analyses, we considered the inclusion of indirect costs, the impact of imperfect adherence to screening strategies, exclusion of confirmatory tests, and lower rates of progression to diabetes.


RESULTS
When annual, biannual, or every 3-year screening strategies were utilized, OGTTs resulted in lower costs per case detected than FPG or A1C. Testing every 3 years resulted in lower costs per case detected compared with more frequent testing. These patterns persisted in sensitivity analyses, except that FPG resulted in lower cost per case detected than OGTT, assuming annual screening and inclusion of indirect costs or assuming annual screening without a confirmatory FPG.


CONCLUSIONS
Screening every 3 years with OGTTs results in the lowest cost per case of detected diabetes.
Kim
Catherine
C
Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan, USA. cathkim@umich.edu
Herman
William H
WH
Vijan
Sandeep
S
D001786:Blood Glucose / Q000032:analysis; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005215:Fasting; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D008824:Michigan; D049590:Postpartum Period / Q000502:physiology*; D011247:Pregnancy; D012680:Sensitivity and Specificity
D001786:Blood Glucose