title: Development of a model to assess the cost-effectiveness of gestational diabetes mellitus screening and lifestyle change for the prevention of type 2 diabetes mellitus.
abstract: Gestational diabetes mellitus (GDM) is increasingly recognized as an opportunity for early prevention of diabetes and other diseases over the lifespan, and may be responsible for up to 30% of cases of type 2 diabetes. A newly developed mathematical model (the GDModel) provides provisional estimates of the cost and health impact of various GDM screening and management choices, and calculates averted disability-adjusted life-years (DALYs). The model was piloted in 5 different healthcare facilities in India and Israel. Universal screening of pregnant women followed by postpartum lifestyle management yielded net savings of US$78 per woman with GDM in India and US$1945 per woman in Israel. The estimated DALYs averted were 2.33 in India and 3.10 in Israel. With lower GDM prevalence, intervention efficacy, and type 2 diabetes incidence, the intervention had a net cost in India, with a cost per DALY averted of US$11.32. This was far below the WHO definition of "very cost-effective," set at annual GDP per capita. The intervention in Israel remained cost-saving. GDM screening and postpartum lifestyle management are either cost-saving or have a net cost but an attractive cost-effectiveness ratio. Some input values are currently being refined. Nevertheless, the current findings of cost-savings or favorable cost-effectiveness are robust to a wide range of plausible input values, including highly unfavorable values. The GDModel will be further developed into a user-friendly tool that can guide policy-makers on decisions regarding GDM screening strategies and guidelines.
authors.affiliation: Global Health Partnerships, Novo Nordisk A/S, Bagsværd, Denmark. nilh@novonordisk.com
authors.forename: Nicolai
authors.initials: N
authors.lastname: Lohse
authors.forename: Elliot
authors.initials: E
authors.lastname: Marseille
authors.forename: James G
authors.initials: JG
authors.lastname: Kahn
mesh_terms: D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006291:Health Policy / Q000191:economics; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007557:Israel / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D008954:Models, Biological; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics; D011297:Prenatal Exposure Delayed Effects / Q000191:economics / Q000453:epidemiology; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D040242:Risk Reduction Behavior