title: The cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes: application of a new model in India and Israel.
abstract: OBJECTIVE
  Gestational diabetes mellitus (GDM) is associated with elevated risks of perinatal complications and type 2 diabetes mellitus, and screening and intervention can reduce these risks. We quantified the cost, health impact and cost-effectiveness of GDM screening and intervention in India and Israel, settings with contrasting epidemiologic and cost environments.
  
  
  METHODS
  We developed a decision-analysis tool (the GeDiForCE™) to assess cost-effectiveness. Using both local data and published estimates, we applied the model for a general medical facility in Chennai, India and for the largest HMO in Israel. We computed costs (discounted international dollars), averted disability-adjusted life years (DALYs) and net cost per DALY averted, compared with no GDM screening.
  
  
  RESULTS
  The programme costs per 1000 pregnant women are $259,139 in India and $259,929 in Israel. Net costs, adjusted for averted disease, are $194,358 and $76,102, respectively. The cost per DALY averted is $1626 in India and $1830 in Israel. Sensitivity analysis findings range from $628 to $3681 per DALY averted in India and net savings of $72,420-8432 per DALY averted in Israel.
  
  
  CONCLUSIONS
  GDM interventions are highly cost-effective in both Indian and Israeli settings, by World Health Organization standards. Noting large differences between these countries in GDM prevalence and costs, GDM intervention may be cost-effective in diverse settings.
authors: Health Strategies International, 555 59th Street, Oakland, CA 94609, USA. emarseille@comcast.net
authors: Elliot
authors: E
authors: Marseille
authors: Nicolai
authors: N
authors: Lohse
authors: Aliya
authors: A
authors: Jiwani
authors: Moshe
authors: M
authors: Hod
authors: Veeraswamy
authors: V
authors: Seshiah
authors: Chittaranjan S
authors: CS
authors: Yajnik
authors: Geeti Puri
authors: GP
authors: Arora
authors: Vijayam
authors: V
authors: Balaji
authors: Ole
authors: O
authors: Henriksen
authors: Nicky
authors: N
authors: Lieberman
authors: Rony
authors: R
authors: Chen
authors: Peter
authors: P
authors: Damm
authors: Boyd E
authors: BE
authors: Metzger
authors: James G
authors: JG
authors: Kahn
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007557:Israel / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics*