title: Screening for gestational diabetes mellitus: are the criteria proposed by the international association of the Diabetes and Pregnancy Study Groups cost-effective?
abstract: OBJECTIVE
  The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recently recommended new criteria for diagnosing gestational diabetes mellitus (GDM). This study was undertaken to determine whether adopting the IADPSG criteria would be cost-effective, compared with the current standard of care.
  
  
  METHODS
  We developed a decision analysis model comparing the cost-utility of three strategies to identify GDM: 1) no screening, 2) current screening practice (1-h 50-g glucose challenge test between 24 and 28 weeks followed by 3-h 100-g glucose tolerance test when indicated), or 3) screening practice proposed by the IADPSG. Assumptions included that 1) women diagnosed with GDM received additional prenatal monitoring, mitigating the risks of preeclampsia, shoulder dystocia, and birth injury; and 2) GDM women had opportunity for intensive postdelivery counseling and behavior modification to reduce future diabetes risks. The primary outcome measure was the incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Our model demonstrates that the IADPSG recommendations are cost-effective only when postdelivery care reduces diabetes incidence. For every 100,000 women screened, 6,178 quality-adjusted life-years (QALYs) are gained, at a cost of $125,633,826. The ICER for the IADPSG strategy compared with the current standard was $20,336 per QALY gained. When postdelivery care was not accomplished, the IADPSG strategy was no longer cost-effective. These results were robust in sensitivity analyses.
  
  
  CONCLUSIONS
  The IADPSG recommendation for glucose screening in pregnancy is cost-effective. The model is most sensitive to the likelihood of preventing future diabetes in patients identified with GDM using postdelivery counseling and intervention.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. ewerner4@jhmi.edu
authors.forename: Erika F
authors.initials: EF
authors.lastname: Werner
authors.forename: Christian M
authors.initials: CM
authors.lastname: Pettker
authors.forename: Lisa
authors.initials: L
authors.lastname: Zuckerwise
authors.forename: Michael
authors.initials: M
authors.lastname: Reel
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Funai
authors.forename: Janice
authors.initials: J
authors.lastname: Henderson
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Thung
mesh_terms: D003362:Cost-Benefit Analysis; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000191:economics*; D005260:Female; D005951:Glucose Tolerance Test / Q000191:economics*; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods; D011247:Pregnancy; D019057:Quality-Adjusted Life Years