Читать книгу Gestational Diabetes - Группа авторов - Страница 64

Concern has been raised regarding the cost and cost-effectiveness of GDM screening even prior to the IADPSG [61–63]. This concern has been raised again, following the IADPSG publication, suggesting that adopting IADPSG recommendations will result in more GDM than the health resources can bear.

Using current testing criteria, the prevalence of GDM in the United States is 5–6%, affecting approximately 240,000 out of 4 million births annually, at a cost of 636 million dollars each year [64]. The lower threshold in the newly suggested criteria will increase the prevalence of GDM by approximately 3-fold, consequently translating into dollars that will be drained from other priorities. The new IADPSG algorithm is expected to increase parameters such as diagnostic workload, maternal – fetal specialist availability, diabetes nurses, and dieticians. It also means more fetal (although limited proof of efficacy) and maternal testing, more labor inductions (some causing iatrogenic prematurity), and more operative and cesarean deliveries (some being unnecessary) with loss of workdays for preforming the OGTT.

Several studies have attempted to address the question whether implementing the IADPSG guidelines will be cost-effective. Agarwal et al. [65] studied the cost and laboratory work loads of the IADPSG criteria vs. the traditional 2-step approach and calculated that it will increase costs by 42% and decrease laboratory work load by 36%. Werner et al. [66] found that the new criteria are cost-effective, but only if postdelivery consultation is provided to reduce the frequency of T2DM. For every 100,000 women, 6,178 quality-adjusted life-years are gained at a cost of more than 125 million dollars. The incremental cost-effectiveness ratio for the IADPSG strategy compared to current standard was 20,336 dollars per a single quality-adjusted life-year gained. Ohno et al. [67] investigated the cost-effectiveness of treating mild GDM (as a secondary analysis of the MFMU-NICHD trial) and found it to be cost-effective for decreasing adverse perinatal outcome. In a follow-up study of IADPSG criteria, Mission et al. [68] concluded that the single 75 g OGTT is more expensive, more effective, and cost-effective at 61,503 dollars per quality-adjusted life-year and would remain such as long as it would reduce preeclampsia by 0.55% and CS rate by 2.7%. Duran et al. [46] demonstrated increased GDM rate and improved neonatal outcomes, with estimated cost savings of EUR 14,358 per 100 women, when using IADPSG criteria.

Although current evidence raise some economic benefits of single 75 g OGTT approach, this may only be true in affluent countries with a high rate of GDM in their population [39].