title: Incremental Cost-Effectiveness Analysis of Gestational Diabetes Mellitus Screening Strategies in Singapore.
abstract: The objective of this study was to conduct an incremental cost-effectiveness analysis from the payer's perspective in Singapore of 3 gestational diabetes mellitus screening strategies: universal, targeted, or no screening. A decision tree model assessed the primary outcome: incremental cost per quality-adjusted life year (QALY) gained. Probabilities, costs, and utilities were derived from the literature, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study, and the KK Women's and Children's Hospital's database. Relative to targeted screening using risk factors, universal screening generates an incremental cost-effectiveness ratio (ICER) of $USD10,630/QALY gained. Sensitivity analyses show that disease prevalence rates and intervention effectiveness of glycemic management have the biggest impacts on the ICERs. Based on the model and best available data, universal screening is a cost-effective approach for reducing the complications of gestational diabetes mellitus in Singapore as compared with the targeted screening approach or no screening.
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.
authors.forename: Pin Yu
authors.initials: PY
authors.lastname: Chen
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Finkelstein
authors.affiliation: KK Women's and Children's Hospital, Singapore.
authors.forename: Mor Jack
authors.initials: MJ
authors.lastname: Ng
authors.affiliation: KK Women's and Children's Hospital, Singapore.
authors.forename: Fabian
authors.initials: F
authors.lastname: Yap
authors.affiliation: KK Women's and Children's Hospital, Singapore.
authors.forename: George S H
authors.initials: GS
authors.lastname: Yeo
authors.affiliation: KK Women's and Children's Hospital, Singapore.
authors.forename: Victor Samuel
authors.initials: VS
authors.lastname: Rajadurai
authors.affiliation: National University of Singapore, National University Health System, Singapore.
authors.forename: Yap Seng
authors.initials: YS
authors.lastname: Chong
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gluckman
authors.affiliation: National University of Singapore, National University Health System, Singapore.
authors.forename: Seang Mei
authors.initials: SM
authors.lastname: Saw
authors.affiliation: KK Women's and Children's Hospital, Singapore.
authors.forename: Kenneth Y C
authors.initials: KY
authors.lastname: Kwek
authors.affiliation: KK Women's and Children's Hospital, Singapore tan.kok.hian@kkh.com.sg.
authors.forename: Kok Hian
authors.initials: KH
authors.lastname: Tan
mesh_terms: D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016640:Diabetes, Gestational / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D018803:Models, Economic; D011247:Pregnancy; D019057:Quality-Adjusted Life Years; D012846:Singapore
keywords: health economics and financing; health services evaluation; health systems; maternal and child health; reproductive epidemiology; women health