Gestational diabetes mellitus (GDM) is associated with an increased risk of perinatal complications and higher risk of developing type2 diabetes mellitus (T2DM). Screening and effective intervention for women with GDM could reduce these risks. This study aimed to assess the cost-effectiveness of the current ADIPS GDM strategy in Australia, including initial screening, antenatal care and postpartum lifestyle management intervention for women with GDM identified by the universal screening following the process and thresholds recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG).
A decision tree model (GeDiForCE) was used in this study. Data on Australian GDM and T2DM epidemiology, intervention costs and literature were used to estimate model parameters. Costs (in Australian dollars $), averted disability-adjusted life years (DALYs) and net cost per DALY averted during life-time horizon were calculated. Sensitivity analyses were also conducted by testing the impact of variations in intervention uptake rate and the effect of intervention in reducing lifetime maternal T2DM risk. No reduction in offspring diabetes risk was assumed.
Compared with no GDM screening, the ADIPS GDM strategy could save money and avert DALYs. The lifetime cost of the ADIPS GDM strategy is $17,384 per patient while no screening costs $24,212. Average DALYs incurred per patient are 0.764 for the GDM strategy and 1.197 for the no screening, resulting in 0.561 DALYs averted using the strategy. Even after lowering the predicted uptake rate of intervention and lowering the estimated risk reduction of T2DM, the ADIPS GDM strategy is still cost-saving.
Using local data and literature estimates, this study shows that the use of ADIPS GDM universal screening and post-partum intervention would lead to cost saving care for pregnant women in Australia. Practical issues remain in terms of supporting women to continue with care, especially in the post-partum period.