Objective This study investigates the cost-effectiveness of gestational diabetes mellitus (GDM) screening using the new IADPSG guidelines. Study Design A decision analytic model was built comparing routine screening with the 2h OGTT vs. the 1-hour GCT. All probabilities, costs, and benefits were derived from the literature. Base-case, sensitivity analyses, and a Monte Carlo simulation were performed. Results Screening with the 2h GTT was more expensive, more effective, and cost-effective at $61,503/QALY. In a one-way sensitivity analysis, the more inclusive IADPSG diagnostic approach remained cost-effective as long an additional 2.0% or more of patients were diagnosed and treated for GDM. Conclusion Screening at 24-28 weeks GA under the new IADPSG guidelines with the 2h GTT is expensive but cost-effective in improving maternal and neonatal outcomes. How the health care system will provide expanded care to this group of women will need to be examined.

OBJECTIVE This study investigated the cost-effectiveness of treating mild gestational diabetes mellitus (GDM). STUDY DESIGN A decision analytic model was built to compare treating vs not treating mild GDM. The primary outcome was the incremental cost per quality-adjusted life year (QALY). All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed. RESULTS Treating mild GDM was more expensive, more effective, and cost-effective at $20,412 per QALY. Treatment remained cost-effective when the incremental cost to treat GDM was less than $3555 or if treatment met at least 49% of its reported efficacy at the baseline cost to treat of $1786. CONCLUSION Treating mild GDM is cost-effective in terms of improving maternal and neonatal outcomes including decreased rates of preeclampsia, cesarean sections, macrosomia, shoulder dystocia, permanent and transient brachial plexus injury, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal intensive care unit admissions.

Noninvasive prenatal testing as a screening tool that requires a confirmatory amniocentesis is cost-effective compared with its use as a diagnostic tool and leads to far fewer losses of normal pregnancies.

We found that human herpesvirus 8-encoded IL-6 (vIL-6) induced endogenous human IL-6 (huIL-6) secretion from various cell lines (MT-4, THP-1, U937, Raji, and CESS) including patients with multicentric Castleman's disease. Especially, in MT-4 cells, huIL-6 was enhanced with vIL-6 by 30-fold compared with that of control. In addition, reverse transcriptase-polymerase chain reaction confirmed that vIL-6 induced huIL-6 expression in MT-4 cells. Our novel finding of the huIL-6 induction by vIL-6 indicates that vIL-6 may play a significant role in the pathogenesis of HHV-8 associated diseases.

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