The cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes: application of a new model in India and Israel

TY - JOUR

T1 - The cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes

T2 - application of a new model in India and Israel

AU - Marseille, Elliot

AU - Lohse, Nicolai

AU - Jiwani, Aliya

AU - Hod, Moshe

AU - Seshiah, Veeraswamy

AU - Yajnik, Chittaranjan S

AU - Arora, Geeti Puri

AU - Balaji, Vijayam

AU - Henriksen, Ole

AU - Lieberman, Nicky

AU - Chen, Rony

AU - Damm, Peter

AU - Metzger, Boyd E

AU - Kahn, James G

PY - 2013/5

Y1 - 2013/5

N2 - Objective: Gestational diabetes mellitus (GDM) is associated with elevated risks of perinatal complications and type 2 diabetes mellitus, and screening and intervention can reduce these risks. We quantified the cost, health impact and cost-effectiveness of GDM screening and intervention in India and Israel, settings with contrasting epidemiologic and cost environments. Methods: We developed a decision-analysis tool (the GeDiForCE™) to assess cost-effectiveness. Using both local data and published estimates, we applied the model for a general medical facility in Chennai, India and for the largest HMO in Israel. We computed costs (discounted international dollars), averted disability-adjusted life years (DALYs) and net cost per DALY averted, compared with no GDM screening. Results: The programme costs per 1000 pregnant women are $259139 in India and $259929 in Israel. Net costs, adjusted for averted disease, are $194358 and $76102, respectively. The cost per DALY averted is $1626 in India and $1830 in Israel. Sensitivity analysis findings range from $628 to $3681 per DALY averted in India and net savings of $72420-8432 per DALY averted in Israel. Conclusion: GDM interventions are highly cost-effective in both Indian and Israeli settings, by World Health Organization standards. Noting large differences between these countries in GDM prevalence and costs, GDM intervention may be cost-effective in diverse settings.

AB - Objective: Gestational diabetes mellitus (GDM) is associated with elevated risks of perinatal complications and type 2 diabetes mellitus, and screening and intervention can reduce these risks. We quantified the cost, health impact and cost-effectiveness of GDM screening and intervention in India and Israel, settings with contrasting epidemiologic and cost environments. Methods: We developed a decision-analysis tool (the GeDiForCE™) to assess cost-effectiveness. Using both local data and published estimates, we applied the model for a general medical facility in Chennai, India and for the largest HMO in Israel. We computed costs (discounted international dollars), averted disability-adjusted life years (DALYs) and net cost per DALY averted, compared with no GDM screening. Results: The programme costs per 1000 pregnant women are $259139 in India and $259929 in Israel. Net costs, adjusted for averted disease, are $194358 and $76102, respectively. The cost per DALY averted is $1626 in India and $1830 in Israel. Sensitivity analysis findings range from $628 to $3681 per DALY averted in India and net savings of $72420-8432 per DALY averted in Israel. Conclusion: GDM interventions are highly cost-effective in both Indian and Israeli settings, by World Health Organization standards. Noting large differences between these countries in GDM prevalence and costs, GDM intervention may be cost-effective in diverse settings.

U2 - 10.3109/14767058.2013.765845

DO - 10.3109/14767058.2013.765845

M3 - Journal article

C2 - 23311860

SN - 1476-7058

VL - 26

SP - 802

EP - 810

JO - Journal of Maternal-Fetal Medicine

JF - Journal of Maternal-Fetal Medicine

IS - 8

ER -