TY - JOUR
T1 - Development of a model to assess the cost-effectiveness of gestational diabetes mellitus screening and lifestyle change for the prevention of type 2 diabetes mellitus
AU - Lohse, Nicolai
AU - Marseille, Elliot
AU - Kahn, James G
N1 - Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd.. All rights reserved.
PY - 2011/11
Y1 - 2011/11
N2 - Gestational diabetes mellitus (GDM) is increasingly recognized as an opportunity for early prevention of diabetes and other diseases over the lifespan, and may be responsible for up to 30% of cases of type 2 diabetes. A newly developed mathematical model (the GDModel) provides provisional estimates of the cost and health impact of various GDM screening and management choices, and calculates averted disability-adjusted life-years (DALYs). The model was piloted in 5 different healthcare facilities in India and Israel. Universal screening of pregnant women followed by postpartum lifestyle management yielded net savings of US$78 per woman with GDM in India and US$1945 per woman in Israel. The estimated DALYs averted were 2.33 in India and 3.10 in Israel. With lower GDM prevalence, intervention efficacy, and type 2 diabetes incidence, the intervention had a net cost in India, with a cost per DALY averted of US$11.32. This was far below the WHO definition of "very cost-effective," set at annual GDP per capita. The intervention in Israel remained cost-saving. GDM screening and postpartum lifestyle management are either cost-saving or have a net cost but an attractive cost-effectiveness ratio. Some input values are currently being refined. Nevertheless, the current findings of cost-savings or favorable cost-effectiveness are robust to a wide range of plausible input values, including highly unfavorable values. The GDModel will be further developed into a user-friendly tool that can guide policy-makers on decisions regarding GDM screening strategies and guidelines.
AB - Gestational diabetes mellitus (GDM) is increasingly recognized as an opportunity for early prevention of diabetes and other diseases over the lifespan, and may be responsible for up to 30% of cases of type 2 diabetes. A newly developed mathematical model (the GDModel) provides provisional estimates of the cost and health impact of various GDM screening and management choices, and calculates averted disability-adjusted life-years (DALYs). The model was piloted in 5 different healthcare facilities in India and Israel. Universal screening of pregnant women followed by postpartum lifestyle management yielded net savings of US$78 per woman with GDM in India and US$1945 per woman in Israel. The estimated DALYs averted were 2.33 in India and 3.10 in Israel. With lower GDM prevalence, intervention efficacy, and type 2 diabetes incidence, the intervention had a net cost in India, with a cost per DALY averted of US$11.32. This was far below the WHO definition of "very cost-effective," set at annual GDP per capita. The intervention in Israel remained cost-saving. GDM screening and postpartum lifestyle management are either cost-saving or have a net cost but an attractive cost-effectiveness ratio. Some input values are currently being refined. Nevertheless, the current findings of cost-savings or favorable cost-effectiveness are robust to a wide range of plausible input values, including highly unfavorable values. The GDModel will be further developed into a user-friendly tool that can guide policy-makers on decisions regarding GDM screening strategies and guidelines.
KW - Cost-Benefit Analysis
KW - Diabetes Mellitus, Type 2/epidemiology
KW - Diabetes, Gestational/diagnosis
KW - Female
KW - Health Policy/economics
KW - Humans
KW - Incidence
KW - India/epidemiology
KW - Israel/epidemiology
KW - Mass Screening/economics
KW - Models, Biological
KW - Pregnancy
KW - Pregnancy Complications/economics
KW - Prenatal Exposure Delayed Effects/economics
KW - Prevalence
KW - Quality-Adjusted Life Years
KW - Risk Reduction Behavior
U2 - 10.1016/S0020-7292(11)60007-6
DO - 10.1016/S0020-7292(11)60007-6
M3 - Journal article
C2 - 22099435
SN - 0020-7292
VL - 115 Suppl 1
SP - S20-5
JO - International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
JF - International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ER -