title: Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods.
abstract: OBJECTIVE
  To conduct a cost minimisation analysis of three methods of gestational diabetes mellitus (GDM) screening and diagnosis.
  
  
  METHODS
  Prospective randomised controlled trial.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Pregnant women (n = 1594) presenting for GDM screening.
  
  
  METHODS
  Women presenting for GDM screening, who consented to participate, were randomised to GR1 [1-hour, 50-g glucose screen (GS) +/- 3-hour, 100-g oral glucose tolerance test (OGTT)], GR2 (50-g GS +/- 2-hour, 75-g OGTT) or GR3 (2-hour, 75-g OGTT). Demographics, health and time/travel cost information were assessed for each glucose testing visit.
  
  
  METHODS
  Costs (direct and indirect) and prevalence of GDM diagnosis.
  
  
  RESULTS
  The direct sampling costs of the glucose tests per woman were as follows: GS, CAN$12.57; 75-g OGTT, $36.10; 100-g OGTT, CAN$48.13. Among women in the two-step method groups diagnosed with GDM, 39% of the GR1 and 61% of the GR2 groups were diagnosed at the first step by GS > or = 10.3 mmol/l, according to the Canadian Diabetes Association recommendations, contributing to a lower total cost in these groups. The total costs per woman screened were as follows: GR1, CAN$91.61; GR2, CAN$89.03; GR3, CAN$108.38. The GDM prevalence was similar (3.7%, 3.7% and 3.6%, respectively). The higher costs of GR3 were related to more blood draws and the time required for all women to undergo the 2-hour OGTT.
  
  
  CONCLUSIONS
  Careful consideration should be given to an internationally recommended method of universal screening for GDM which minimises the burden and cost for individual women and the healthcare system, yet provides diagnostic efficacy. The two-step method (GS +/- OGTT) accomplished this better than the one-step method (75-g OGTT).
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine and Obstetrics and Gynecology, Faculty of Medicine, McGill University Health Center, 687 Pine Avenue West, Montreal, QC, Canada. sara.meltzer@mcgill.ca
authors.forename: S J
authors.initials: SJ
authors.lastname: Meltzer
authors.forename: J
authors.initials: J
authors.lastname: Snyder
authors.forename: J R
authors.initials: JR
authors.lastname: Penrod
authors.forename: M
authors.initials: M
authors.lastname: Nudi
authors.forename: L
authors.initials: L
authors.lastname: Morin
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology; D005260:Female; D005951:Glucose Tolerance Test / Q000191:economics; D006801:Humans; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics*; D011446:Prospective Studies; D011792:Quebec