Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis
Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis
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DOI：
10.1016/j.ajog.2012.06.048
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发表时间：
2012-10-01
影响因子：
9.8
通讯作者：
Caughey, Aaron B.
中科院分区：
文献类型：
--
作者：
Mission, John F.;Ohno, Mika S.;Caughey, Aaron B.
目的：本研究利用新的国际妊娠糖尿病协会研究组（IADPSG）指南调查妊娠期糖尿病筛查的成本效益。研究设计：建立比较常规筛查与2小时口服葡萄糖耐量试验（OGTT）和1小时葡萄糖激发试验的决策分析模型。所有的概率、成本和收益均来自文献。进行了基本情况、敏感性分析和蒙特卡罗模拟。结果：使用2h OGTT筛查更昂贵，更有效，成本效益为61,503美元/质量调整生命年。在单向敏感性分析中，只要有2.0%或更多的患者被诊断和治疗妊娠糖尿病，更具包容性的IADPSG诊断方法仍然具有成本效益。结论：根据新的IADPSG指南，24-28周孕龄筛查和2h OGTT是昂贵的，但在改善孕产妇和新生儿结局方面具有成本效益。卫生保健系统将如何向这一妇女群体提供扩大的护理将需要加以审查。
OBJECTIVE: This study investigates the cost effectiveness of gestational diabetes mellitus screening using the new International Association of Diabetes in Pregnancy Study Group (IADPSG) guidelines.STUDY DESIGN: A decision analytic model was built comparing routine screening with the 2-hour (2h) oral glucose tolerance test (OGTT) vs the 1-hour glucose challenge test. All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed.RESULTS: Screening with the 2h OGTT was more expensive, more effective, and cost effective at $61,503/quality-adjusted life year. In a 1-way sensitivity analysis, the more inclusive IADPSG diagnostic approach remained cost effective as long as an additional 2.0% or more of patients were diagnosed and treated for gestational diabetes mellitus.CONCLUSION: Screening at 24-28 weeks' gestational age under the new IADPSG guidelines with the 2h OGTT is expensive but cost effective in improving maternal and neonatal outcomes. How the health care system will provide expanded care to this group of women will need to be examined.