The short-term health and economic burden of gestational diabetes mellitus in China: a modelling study

Abstract

Objectives: Gestational diabetes mellitus (GDM) is associated with a higher risk for adverse health outcomes during pregnancy and delivery for both mothers and babies. This study aims to assess the short-term health and economic burden of GDM in China in 2015.

Design: Using TreeAge Pro, an analytical decision model was built to estimate the incremental costs and quality-of-life loss due to GDM, in comparison with pregnancy without GDM from the 28th gestational week until and including childbirth. The model was populated with probabilities and costs based on current literature, clinical guidelines, price lists and expert interviews. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results.

Participants: Chinese population who gave birth in 2015.

Results: On average, the cost of a pregnancy with GDM was ¥6677.37 (in 2015 international $1929.87) more (+95%) than a pregnancy without GDM, due to additional expenses during both the pregnancy and delivery: ¥4421.49 for GDM diagnosis and treatment, ¥1340.94 (+26%) for the mother's complications and ¥914.94 (+52%) for neonatal complications. In China, 16.5 million babies were born in 2015. Given a GDM prevalence of 17.5%, the number of pregnancies affected by GDM was estimated at 2.90 million in 2015. Therefore, the annual societal economic burden of GDM was estimated to be ¥19.36 billion (international $5.59 billion). Sensitivity analyses were used to confirm the robustness of the results. Incremental health losses were estimated to be approximately 260 000 quality-adjusted life years.

Conclusion: In China, the GDM economic burden is significant, even in the short-term perspective and deserves more attention and awareness. Our findings indicate a clear need to implement GDM prevention and treatment strategies at a national level in order to reduce the economic and health burden at both the population and individual levels.

Keywords: china; economic burden; gestational diabetes mellitus; health burden.

Figure 1

GDM diagnosis and treatment model. This figure shows the generic framework of GDM screening path as recommended by Chinese guidelines. Circles represent chance events, while triangles represent terminal nodes. The symbol ‘#’ indicates that the probabilities of that branch are complementary with that of the other one. GDM, gestational diabetes mellitus; OGTT, oral glucose tolerance test.

Figure 2

Maternal complications model. This figure shows the mother complications model, which has the same structure for both gestational diabetes mellitus and Euglycaemia branches. The symbol ‘#’ indicates that the probabilities of that branch are complementary with that of the other one. Circles represent chance events, while triangles represent terminal nodes. Lines that do not terminate in a triangle are collapsed to facilitate display and are analogous to branches that are open.

Figure 3

Neonatal complications model. This figure shows the neonatal complications model, which has the same structure for both gestational diabetes mellitus and Euglycaemia branches. Circles represent chance events, while triangles represent terminal nodes.