Global cost-effectiveness of GDM screening and management: current knowledge and future needs

Area of Science:

• Reproductive Endocrinology
• Health Economics
• Public Health Policy

Background:

• Gestational diabetes mellitus (GDM) presents increasing morbidity risks for mothers and infants.
• Early screening and intervention are crucial for mitigating perinatal and long-term diabetes complications.
• Existing economic evaluations of GDM interventions lack recent systematic comparison.

Purpose of the Study:

• To systematically review and compare cost-effectiveness and cost-utility studies of GDM screening and intervention from 2002-2014.
• To identify factors contributing to the wide variation in economic findings.
• To provide recommendations for future economic research on GDM.

Main Methods:

• Systematic literature search and data abstraction of cost-effectiveness and cost-utility studies.
• Standardization of all economic findings to 2014 US dollars for comparability.
• Analysis of variations based on geographic setting, diagnostic criteria, intervention strategies, and outcome inclusion (e.g., long-term type 2 diabetes risk).

Main Results:

• Cost-effectiveness ratios for GDM interventions demonstrated significant variability.
• Geographic setting, diagnostic criteria, intervention approaches, and inclusion of long-term outcomes were key drivers of cost-effectiveness variation.
• Incorporating long-term benefits substantially impacts cost-effectiveness estimates.

Conclusions:

• The methodological heterogeneity and varied results preclude global recommendations for GDM screening and treatment economics.
• Future economic studies must incorporate long-term outcomes and adapt to local preferences and diagnostic criteria (e.g., IADPSG).
• Long-term health benefits significantly influence the economic value of GDM management.