Screening for gestational diabetes mellitus: cost-utility of different screening strategies based on a woman's individual risk of disease

Round, J.A., Jacklin, P., Fraser, R.B., Hughes, R.G., Mugglestone, M.A. and Holt, R.I.G. (2011) Screening for gestational diabetes mellitus: cost-utility of different screening strategies based on a woman's individual risk of disease. Diabetologia, 54, (2), 256-263. (doi:10.1007/s00125-010-1881-y). (PMID:20809381).


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Aims/hypothesis: the cost-effectiveness of eight strategies for screening for gestational diabetes (including no screening) was estimated with respect to the level of individual patient risk.

Methods: cost–utility analysis using a decision analytic model populated with efficacy evidence pooled from recent randomised controlled trials, from the funding perspective of the National Health Service in England and Wales. Seven screening strategies using various combinations of screening and diagnostic tests were tested in addition to no screening. The primary outcome measure was the incremental cost per quality-adjusted life-year (QALY) over a lifetime.

Results: the strategy that has the greatest likelihood of being cost-effective is dependent on the risk of gestational diabetes mellitus for each individual woman. When gestational diabetes mellitus risk is <1% then the no screening/treatment strategy is cost-effective; where risk is between 1.0% and 4.2% fasting plasma glucose followed by OGTT is most likely to be cost-effective; and where risk is >4.2%, universal OGTT is most likely to be cost-effective. However, acceptability of the test alters the most cost-effective strategy.

Conclusions/interpretation: screening for gestational diabetes can be cost-effective. The best strategy is dependent on the underlying risk of each individual and the acceptability of the tests used. The current study suggests that if a woman’s individual risk of gestational diabetes could be accurately predicted, then healthcare resource allocation could be improved by providing an individualised screening strategy

Item Type: Article
Digital Object Identifier (DOI): doi:10.1007/s00125-010-1881-y
ISSNs: 0012-186X (print)
1432-0428 (electronic)
Keywords: cost effectiveness, gestational diabetes, screening, risk factors, cost–utility
Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
Q Science > QR Microbiology > QR180 Immunology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions : University Structure - Pre August 2011 > School of Medicine > Developmental Origins of Health and Disease
ePrint ID: 166041
Accepted Date and Publication Date:
February 2011Published
Date Deposited: 21 Oct 2010 13:17
Last Modified: 31 Mar 2016 13:30

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