Exploring Structural Uncertainty in Cost-Effectiveness Modeling of Gestational Diabetes Screening: An Application...

Area of Science:

• Health Economics
• Public Health Policy
• Maternal Health

Background:

• Screening for gestational diabetes mellitus (GDM) in Norway has expanded, but optimal eligibility criteria remain debated.
• Assessing cost-effectiveness is crucial for refining GDM screening strategies.

Purpose of the Study:

• To compare the cost-effectiveness of four GDM screening strategies in Norway: universal, current guidelines, high-risk, and no screening.
• To explore structural uncertainty and the value of future research in GDM screening eligibility criteria.

Main Methods:

• A probabilistic decision tree model was developed to estimate costs and quality-adjusted life-years (QALYs).
• Four strategies were evaluated: universal, current, high-risk, and no screening.
• Scenario and value-of-information analyses were conducted to address uncertainty, including effects on type 2 diabetes mellitus (T2DM) and perinatal death.

Main Results:

• Current Norwegian screening recommendations were found to be inefficient across all analyses.
• Universal screening was the most cost-effective strategy in the primary analysis ($26,014/QALY gained).
• High-risk screening became preferred when no preventive effect of GDM treatment on T2DM was assumed ($19,115/QALY gained).

Conclusions:

• The optimal GDM screening strategy depends on the inclusion of treatment effects on perinatal death and T2DM.
• High decision uncertainty exists, particularly concerning long-term maternal outcomes.
• Further research on the long-term effects of GDM screening and treatment is recommended to reduce uncertainty.