Treating mild gestational diabetes mellitus: a cost-effectiveness analysis

Ohno, Mika; Sparks, Teresa N.; Cheng, Yvonne W.; Caughey, Aaron B.

doi:10.1016/j.ajog.2011.06.051

Cited by 57 publications

(60 citation statements)

References 26 publications

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“…32, 35 Yet a 2011 study by Ohno et al on diabetes treatment during pregnancy counted fetal loss as a loss of QALYs to the mother as well as a loss of QALYs for a future child. 20 …”

Section: Resultsmentioning

confidence: 99%

Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing

Goldhaber-Fiebert

Brandeau

2015

Med Decis Making

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Background Current guidelines for economic evaluations of health interventions define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on counting health impacts on current and future fertility and childbearing. Objective To characterize current practices for counting such health outcomes. Design We developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing and how such outcomes are reported. We identified interventions spanning the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on QALYs associated with fertility and childbearing. Results We reviewed 108 studies, identifying seven themes: 1) Studies were heterogeneous in reporting outcomes. 2) Studies often selected outcomes for inclusion that tend to bias toward finding the intervention to be cost-effective. 3) Studies often avoided the challenges of assigning QALYs for pregnancy and fertility by instead considering cost per intermediate outcome. 4) Even for the same intervention, studies took heterogeneous approaches to outcome evaluation. 5) Studies employed multiple, competing rationales for whether and how to include fertility-related QALYs and whose QALYs to include. 6) Studies examining interventions with indirect effects on fertility typically ignored such QALYs. 7) Even recent studies had these shortcomings. Limitations The review was targeted rather than systematic. Conclusions Economic evaluations inconsistently consider QALYs from current and future fertility and childbearing in ways that frequently appear biased towards the interventions considered. As the Panel on Cost-Effectiveness in Health and Medicine updates its guidelines, making the practice of cost-effectiveness analysis more consistent is a priority. Our study contributes to harmonizing methods in this respect.

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“…32, 35 Yet a 2011 study by Ohno et al on diabetes treatment during pregnancy counted fetal loss as a loss of QALYs to the mother as well as a loss of QALYs for a future child. 20 …”

Section: Resultsmentioning

confidence: 99%

Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing

Goldhaber-Fiebert

Brandeau

2015

Med Decis Making

View full text Add to dashboard Cite

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“…1,3 As the presence of macrosomia affects the probability of shoulder dystocia, brachial plexus injury, hypoglycemia, and hyperbilirubinemia, these probabilities were derived from a separate body of work that examined these factors independently in patients with GDM. 12-14 Probabilities for maternal death were also derived from the literature. 15 …”

Section: Methodsmentioning

confidence: 99%

Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis

Mission

Ohno

Cheng

et al. 2012

American Journal of Obstetrics and Gynecology

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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.

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“…Intensive monitoring and, to a lesser extent, pharmacological treatments are applied to a large number of patients to improve outcomes in a relative few. Even if this approach could be shown to be cost effective, 46 it is almost certainly inefficient. In truth, when it comes to perinatal complications, GDM is more of a risk factor than a disease.…”

Section: Can the Risks Of Gdm Be Reduced?mentioning

confidence: 99%

Gestational diabetes mellitus: risks and management during and after pregnancy

2012

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Gestational diabetes mellitus (GDM) represents glucose levels in the high end of the population distribution during pregnancy. GDM carries a small but potentially important risk of adverse perinatal outcomes and a longer-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements compliment maternal glucose measurements in identifying pregnancies that need such intensification. Glucose testing shortly after pregnancy can stratify the near-term diabetes risk in mothers, Thereafter, annual glucose and HbA1C testing can detect deteriorating glycaemic control, a harbinger of future diabetes, usually type 2. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning allows optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity.

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Treating mild gestational diabetes mellitus: a cost-effectiveness analysis

Cited by 57 publications

References 26 publications

Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing

Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing

Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis

Gestational diabetes mellitus: risks and management during and after pregnancy

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