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. 2011 Sep;205(3):282.e1-7.
doi: 10.1016/j.ajog.2011.06.051. Epub 2011 Jun 21.

Treating mild gestational diabetes mellitus: a cost-effectiveness analysis

Mika S Ohno  1 , Teresa N Sparks, Yvonne W Cheng, Aaron B Caughey
Affiliations

Treating mild gestational diabetes mellitus: a cost-effectiveness analysis

Mika S Ohno et al. Am J Obstet Gynecol. 2011 Sep.

Abstract

Objective: This study investigated the cost-effectiveness of treating mild gestational diabetes mellitus (GDM).

Study design: A decision analytic model was built to compare treating vs not treating mild GDM. The primary outcome was the incremental cost per quality-adjusted life year (QALY). All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed.

Results: Treating mild GDM was more expensive, more effective, and cost-effective at $20,412 per QALY. Treatment remained cost-effective when the incremental cost to treat GDM was less than $3555 or if treatment met at least 49% of its reported efficacy at the baseline cost to treat of $1786.

Conclusion: Treating mild GDM is cost-effective in terms of improving maternal and neonatal outcomes including decreased rates of preeclampsia, cesarean sections, macrosomia, shoulder dystocia, permanent and transient brachial plexus injury, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal intensive care unit admissions.

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Figures

FIGURE 1
FIGURE 1. The decision analytic model comparing treating vs not treating mild GDM
Not all branches are shown to facilitate display. Lines that do not terminate in a circle or a triangle indicate they are collapsed to facilitate display and are the same as branches that are already open. GDM, gestational diabetes mellitus. Ohno. Treating mild gestational diabetes mellitus: a cost-effectiveness analysis. Am J Obstet Gynecol 2011.
FIGURE 2
FIGURE 2. Sensitivity analyses
A, Tornado diagram showing how varying the costs affects the incremental cost-effectiveness ratio (ICER). Only increasing the incremental cost of treating GDM above $3555 can make treating GDM not cost-effective (ICER >$100,000/QALY). B, Univariate sensitivity analysis on the incremental cost to treat mild GDM. At a cost of $1330 to treat, treating mild GDM becomes more expensive than not treating but still cost-effective. Treating mild GDM was no longer cost-effective if the cost to treat was greater than $3555. C, Univariate analysis on the efficacy of treatment. 1, 100% efficacy; 0, no difference between treatment and no treatment. At the baseline cost of $1786 to treat GDM, treating mild GDM is cost-effective as long as treatment meets at least 49% of its expected results. D, Two-way sensitivity analysis on the cost to treat GDM vs efficacy of treatment. The blue-hatch region represents where treating GDM is cost-effective (below the cost-effectiveness threshold of $100,000/QALY). At 100% efficacy, the cost to treat can be as high as $3555 and be cost-effective (baseline case). As the treatment efficacy decreases, the cost at which treating GDM no longer becomes cost-effective decreases. At the baseline cost of $1786 to treat GDM, treatment can be as low as 49% and still be cost-effective. GDM, gestational diabetes mellitus; QALY, quality-adjusted life year. Ohno. Treating mild gestational diabetes mellitus: a cost-effectiveness analysis. Am J Obstet Gynecol 2011.
FIGURE 3
FIGURE 3. Monte Carlo simulation of 10,000 random women
Monte Carlo simulation of 10,000 random women shows there is a 70% probability that treatment is cost-effective at a threshold of $100,000/quality-adjusted life year. Ohno. Treating mild gestational diabetes mellitus: a costeffectiveness analysis. Am J Obstet Gynecol 2011.
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References

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