Economic Evaluations of Gestational Diabetes Mellitus Screening: A Systematic Review

Abstract

Background This study aims to find evidence of the cost-effectiveness of gestational diabetes mellitus (GDM) screening and assess the quality of current economic evaluations, which have shown different conclusions with a variation in screening methods, data sources, outcome indicators, and implementation in diverse organizational contexts. Methods Embase, Medline, Web of Science, Health Technology Assessment, database, and National Health Service Economic Evaluation Database databases were searched through June 2019. Studies on economic evaluation reporting both cost and health outcomes of GDM screening programs in English language were selected, and the quality of the studies was assessed using Drummond’s checklist. The general characteristics, main assumptions, and results of the economic evaluations were summarized. Results Our search yielded 10 eligible economic evaluations with different screening strategies compared in different settings and perspectives. The selected papers scored 81% (68–97%) on the items in Drummond’s checklist on average. In general, a screening program is cost-effective or even dominant over no screening. The one-step screening, with more cases detected, is more likely to be cost-effective than the two-step screening. Universal screening is more likely to be cost-effective than screening targeting the high-risk population. Parameters affecting cost-effectiveness include: diagnosis criteria, epidemiological characteristics of the population, efficacy of screening and treatment, and costs. Conclusions Most studies found GDM screening to be cost-effective, though uncertainties remain due to many factors. The quality assessment identified weaknesses in the economic evaluations in terms of integrating existing data, measuring costs and consequences, analyzing perspectives, and adjusting for uncertainties.

2. Classification and Diagnosis of Diabetes:Standards of Care in Diabetes—2023

“…The conflicting recommendations from expert groups underscore the fact that there are data to support each strategy. A systematic review of economic evaluations of GDM screening found that the one-step method identified more cases of GDM and was more likely to be costeffective than the two-step method (254). The decision of which strategy to implement must therefore be made based on the relative values placed on factors that have yet to be measured (e.g., willingness to change practice based on correlation studies rather than intervention trial results, available infrastructure, and importance of cost considerations).…”

Gestational Diabetes Mellitus—Innovative Approach to Prediction, Diagnosis, Management, and Prevention of Future NCD—Mother and Offspring

“…Nonetheless, some authorities, notably the National Institute for Clinical Excellence (NICE) in the UK, still promote risk factor based screening ( 29 ). The most recent Cochrane review ( 30 ) is inconclusive, but a recent systematic review of economic evaluations of GDM screening again concluded that universal screening was the most effective approach ( 31 ). Compliance with officially endorsed risk factor based screening protocols appears to be poor in countries as diverse as Sweden ( 32 ), where only 31% of women received the screening test deemed appropriate for their documented risk factor profile, the UK (61% appropriate screening according to risk factors) ( 33 ) and South Africa ( 34 ), where Adam et al reported that, although use of risk factors would reduce OGTTs by 46%, this protocol would miss 41% of GDM diagnoses ( 34 ).…”

Screening of Gestational Diabetes and Its Risk Factors: Pregnancy Outcome of Women with Gestational Diabetes Risk Factors According to Glycose Tolerance Test Results

“…Another option to improve GDM diagnostics would be universal screening, ensuring that every woman is at least offered testing. Universal testing would result in the maximum number of GDM cases at the expense of increased healthcare costs and the workload of clinical personnel; however, overall, this tends to be cost-effective [ 26 ]. As GDM also bears responsibility for long-term complications, mothers and offspring would benefit from universal screening and lifestyle interventions when considering their health risks in later life.…”