Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one‐step and two‐step methods

Abstract

Objective To conduct a cost minimisation analysis of three methods of gestational diabetes mellitus (GDM) screening and diagnosis.Design Prospective randomised controlled trial.Setting University teaching hospital.Population Pregnant women (n = 1594) presenting for GDM screening.Methods Women presenting for GDM screening, who consented to participate, were randomised to GR1 [1-hour, 50-g glucose screen (GS) ± 3-hour, 100-g oral glucose tolerance test (OGTT)], GR2 (50-g GS ± 2-hour, 75-g OGTT) or GR3 (2-hour, 75-g OGTT). Demographics, health and time/travel cost information were assessed for each glucose testing visit.Main outcome measures Costs (direct and indirect) and prevalence of GDM diagnosis.Results The direct sampling costs of the glucose tests per woman were as follows: GS, CAN$12.57; 75-g OGTT, $36.10; 100-g OGTT, CAN$48.13. Among women in the two-step method groups diagnosed with GDM, 39% of the GR1 and 61% of the GR2 groups were diagnosed at the first step by GS ‡ 10.3 mmol/l, according to the Canadian Diabetes Association recommendations, contributing to a lower total cost in these groups. The total costs per woman screened were as follows: GR1, CAN$91.61; GR2, CAN$89.03; GR3, CAN$108.38. The GDM prevalence was similar (3.7%, 3.7% and 3.6%, respectively). The higher costs of GR3 were related to more blood draws and the time required for all women to undergo the 2-hour OGTT.Conclusions Careful consideration should be given to an internationally recommended method of universal screening for GDM which minimises the burden and cost for individual women and the healthcare system, yet provides diagnostic efficacy. The two-step method (GS ± OGTT) accomplished this better than the one-step method (75-g OGTT).Keywords Cost analysis, diagnosis, direct/indirect costs, gestational diabetes mellitus, oral glucose tolerance test, screening.Please cite this paper as: Meltzer S, Snyder J, Penrod J, Nudi M, Morin L. Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods. BJOG 2010;117:407-415.

A two-step screening algorithm including fasting plasma glucose measurement and a risk estimation model is an accurate strategy for detecting gestational diabetes mellitus

“…Regarding the cost-effectiveness of various procedures, a randomised cost-minimisation analysis found that one-step screening (2 h OGTT, Canadian Diabetes Association criteria) was more expensive than two-step approaches including a glucose challenge test based on time expenditure and analyses of multiple blood samples [36]. Another very recent decision analysis suggested that the IADPSG criteria are cost-effective, if post-delivery care is accomplished aiming to reduce diabetes incidence at follow-up.…”

Maternal and Fetal Outcome in Gestational Diabetes Mellitus—A Study at Tertiary Health Centre in Northern India

“…Nearly 50% of women with GDM will become will become overt diabetes (Type-2) over a period of 5 -20 years [3]. Depending on geographical location and diagnostic methods used, the prevalence of GDM varied from 3.8% -21% in different parts of the India [4]. As Asian ethnic background has been identified as a risk factor, and hence, screening should be offered to all pregnant women for GDM [5].…”

Recommendations on screening for type 2 diabetes in adults

“…Approximate costs are $6-$8 for A1C, 38 $6-$10 for a fasting blood glucose test 39 and $30 for an oral glucose tolerance test. 40 …”