V. Seshiah

The cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes: application of a new model in India and Israel

Abstract Objective: Gestational diabetes mellitus (GDM) is associated with elevated risks of perinatal complications and type 2 diabetes mellitus, and screening and intervention can reduce these risks. We quantified the cost, health impact and cost-effectiveness of GDM screening and intervention in India and Israel, settings with contrasting epidemiologic and cost environments. Methods: We developed a decision-analysis tool (the GeDiForCE™) to assess cost-effectiveness. Using both local data and published estimates, we applied the model for a general medical facility in Chennai, India and for the largest HMO in Israel. We computed costs (discounted international dollars), averted disability-adjusted life years (DALYs) and net cost per DALY averted, compared with no GDM screening. Results: The programme costs per 1000 pregnant women are

Detection and care of women with gestational diabetes mellitus from early weeks of pregnancy results in birth weight of newborn babies appropriate for gestational age

259 139 in India and

Diagnosis of gestational diabetes mellitus in Asian-Indian women

259 929 in Israel. Net costs, adjusted for averted disease, are

Current status of management, control, complications and psychosocial aspects of patients with diabetes in India: Results from the DiabCare India 2011 Study

194 358 and

Inadequacy of fasting plasma glucose to diagnose gestational diabetes mellitus in Asian Indian women

76 102, respectively. The cost per DALY averted is

Maternal serum biomarkers for risk assessment in gestational diabetes. A potential universal screening test to predict GDM status

1626 in India and

Women diagnosed with gestational diabetes mellitus do not carry antibodies against minor islet cell antigens.

1830 in Israel. Sensitivity analysis findings range from

Baseline characteristics of the IMPROVE control study population: A study to evaluate the effectiveness of a standardized healthcare professionals training program

628 to

Classification of hyperglycemia in pregnancy

3681 per DALY averted in India and net savings of

Physicians' perceptions of a national consensus guideline on insulin therapy: Data from the IMPACT study.

72 420–8432 per DALY averted in Israel. Conclusion: GDM interventions are highly cost-effective in both Indian and Israeli settings, by World Health Organization standards. Noting large differences between these countries in GDM prevalence and costs, GDM intervention may be cost-effective in diverse settings.