Screening for Gestational Diabetes Mellitus
A decision and cost-effectiveness analysis of four screening strategies
- Wanda K. Nicholson, MD, MPH12,
- Lee A. Fleisher, MD3,
- Harold E. Fox, MD, MHS1 and
- Neil R. Powe, MD, MPH, MBA456
- 1Department of Gynecology and Obstetrics, The Johns Hopkins School of Medicine, Baltimore, Maryland
- 2Department of Population and Family Health Sciences, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- 3Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- 4Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
- 5Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins School of Medicine, Baltimore, Maryland
- 6Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Address correspondencereprint requests to Wanda Nicholson, MD, MPH, Department of GynecologyObstetrics, The Johns Hopkins School of Medicine, 600 North Wolfe St., Phipps 247, Baltimore, MD 21287. E-mail: wnichol{at}jhmi.edu
Gestational diabetes mellitus (GDM), defined as carbohydrate intolerance of variable degree with onset or first recognition during pregnancy, is the most common medical condition of pregnancy. GDM affects ∼190,000 (4–5%) of the >4 million births occurring annually in the U.S. and is associated with several maternal and infant complications (1). Worldwide, the three primary screening strategies for GDM are the sequential strategy (initial 50-g glucose challenge test followed by, in those who test positive, a 100-g glucose tolerance test [GTT]), the 75-g GTT strategy, and the 100-g GTT strategy (2). The efficacy of these strategies, however, is debated. There are few randomized trials on the effectiveness of GDM screening (3). Yet, the majority of U.S. obstetricians provide universal screening for GDM (4).
We conducted a cost-effectiveness analysis to compare four screening strategies for universal screening of GDM, including the sequential strategy, the 75- and 100-g GTT, and a no-screening strategy. We assessed the relative cost and effectiveness (quality-adjusted life-years [QALYs]) of each strategy relative to the sequential strategy using a decision model.
RESEARCH DESIGN AND METHODS
We performed a decision and cost-effectiveness analysis from a societal perspective that incorporates all health effects and medical resources consumed regardless of who pays (5). Separate cost-effectiveness ratios were estimated for mothers and infants. Maternal outcomes were hypertensive disease, polyhydramnios, cesarean or vaginal delivery, …
