title: The cost-effectiveness of screening for gestational diabetes mellitus in primary and secondary care in the Republic of Ireland.
abstract: OBJECTIVE
  The aim of the study was to assess the cost-effectiveness of screening for gestational diabetes mellitus (GDM) in primary and secondary care settings, compared with a no-screening option, in the Republic of Ireland.
  
  
  METHODS
  The analysis was based on a decision-tree model of alternative screening strategies in primary and secondary care settings. It synthesised data generated from a randomised controlled trial (screening uptake) and from the literature. Costs included those relating to GDM screening and treatment, and the care of adverse outcomes. Effects were assessed in terms of quality-adjusted life years (QALYs). The impact of the parameter uncertainty was assessed in a range of sensitivity analyses.
  
  
  RESULTS
  Screening in either setting was found to be superior to no screening, i.e. it provided for QALY gains and cost savings. Screening in secondary care was found to be superior to screening in primary care, providing for modest QALY gains of 0.0006 and a saving of €21.43 per screened case. The conclusion held with high certainty across the range of ceiling ratios from zero to €100,000 per QALY and across a plausible range of input parameters.
  
  
  CONCLUSIONS
  The results of this study demonstrate that implementation of universal screening is cost-effective. This is an argument in favour of introducing a properly designed and funded national programme of screening for GDM, although affordability remains to be assessed. In the current environment, screening for GDM in secondary care settings appears to be the better solution in consideration of cost-effectiveness.
authors.affiliation: J. E. Cairnes School of Business and Economics, National University of Ireland Galway, H91TK33, Galway, Ireland. danyliv@gmail.com.|School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland. danyliv@gmail.com.
authors.forename: Andriy
authors.initials: A
authors.lastname: Danyliv
authors.affiliation: J. E. Cairnes School of Business and Economics, National University of Ireland Galway, H91TK33, Galway, Ireland.
authors.forename: Paddy
authors.initials: P
authors.lastname: Gillespie
authors.affiliation: J. E. Cairnes School of Business and Economics, National University of Ireland Galway, H91TK33, Galway, Ireland.
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.affiliation: School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.|Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
authors.forename: Marie
authors.initials: M
authors.lastname: Tierney
authors.affiliation: School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.|Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
authors.forename: Angela
authors.initials: A
authors.lastname: O'Dea
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.|School of Psychology, National University of Ireland Galway, Galway, Ireland.
authors.forename: Brian E
authors.initials: BE
authors.lastname: McGuire
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.|Discipline of General Practice, National University of Ireland Galway, Galway, Ireland.
authors.forename: Liam G
authors.initials: LG
authors.lastname: Glynn
authors.affiliation: School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.|Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
authors.forename: Fidelma P
authors.initials: FP
authors.lastname: Dunne
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D016640:Diabetes, Gestational / Q000191:economics*; D005260:Female; D006801:Humans; D007494:Ireland; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D063127:Secondary Health Care / Q000191:economics / Q000706:statistics & numerical data
keywords: Cost-effectiveness; Costs and cost analysis; Cost–utility analysis; Economic evaluation; Gestational diabetes mellitus; Screening