Cost-effectiveness of Strategies for Postpartum Glucose Intolerance Testing

Area of Science:

• Reproductive Endocrinology
• Metabolic Disorders
• Health Economics

Background:

• Gestational diabetes mellitus (GDM) can lead to persistent postpartum glucose metabolism abnormalities.
• Effective postpartum screening strategies are essential for early detection and management of glucose intolerance.
• This study evaluates the cost-effectiveness of different postpartum screening approaches.

Purpose of the Study:

• To compare the cost and effectiveness of four distinct postpartum glucose intolerance screening strategies.
• To identify influencing variables on the cost-effectiveness of these strategies.
• To provide a model for guiding postpartum glucose intolerance screening protocols.

Main Methods:

• A decision model was employed to compare four screening strategies: inpatient fasting capillary glucose (FCG) alone, inpatient FCG with 2-hour oral glucose tolerance test (OGTT), inpatient FCG with home FCG testing, and no screening.
• Data on clinical probabilities and costs were sourced from institutional records, literature, and pricing data.
• Primary outcomes included per-patient cost, effectiveness in detecting diabetes and prediabetes, and incremental cost-effectiveness ratios (ICERs).

Main Results:

• Strategy costs ranged from $1167 to $1330, with effectiveness between 0% and 25%.
• Home FCG testing (strategy 3) was the most effective and expensive compared to the 2-hour OGTT (strategy 2), with an ICER of $837.
• Strategy 2 was more effective and costly than inpatient FCG alone (strategy 1), with an ICER of $571.

Conclusions:

• Home FCG testing presents a viable alternative to the 2-hour OGTT, particularly when patient adherence to the OGTT is low.
• The developed model can aid in optimizing postpartum glucose intolerance screening protocols.
• Early diagnosis and intervention are facilitated by effective screening, minimizing missed opportunities.