Andriy Danyliv1,2, Paddy Gillespie3, Ciaran O'Neill3, Marie Tierney4,5, Angela O'Dea4,5, Brian E McGuire5,6, Liam G Glynn5,7, Fidelma P Dunne4,5. 1. J. E. Cairnes School of Business and Economics, National University of Ireland Galway, H91TK33, Galway, Ireland. danyliv@gmail.com. 2. School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland. danyliv@gmail.com. 3. J. E. Cairnes School of Business and Economics, National University of Ireland Galway, H91TK33, Galway, Ireland. 4. School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland. 5. Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland. 6. School of Psychology, National University of Ireland Galway, Galway, Ireland. 7. Discipline of General Practice, National University of Ireland Galway, Galway, Ireland.
Abstract
AIMS/HYPOTHESIS: The aim of the study was to assess the cost-effectiveness of screening for gestational diabetes mellitus (GDM) in primary and secondary care settings, compared with a no-screening option, in the Republic of Ireland. METHODS: The analysis was based on a decision-tree model of alternative screening strategies in primary and secondary care settings. It synthesised data generated from a randomised controlled trial (screening uptake) and from the literature. Costs included those relating to GDM screening and treatment, and the care of adverse outcomes. Effects were assessed in terms of quality-adjusted life years (QALYs). The impact of the parameter uncertainty was assessed in a range of sensitivity analyses. RESULTS: Screening in either setting was found to be superior to no screening, i.e. it provided for QALY gains and cost savings. Screening in secondary care was found to be superior to screening in primary care, providing for modest QALY gains of 0.0006 and a saving of €21.43 per screened case. The conclusion held with high certainty across the range of ceiling ratios from zero to €100,000 per QALY and across a plausible range of input parameters. CONCLUSIONS/ INTERPRETATION: The results of this study demonstrate that implementation of universal screening is cost-effective. This is an argument in favour of introducing a properly designed and funded national programme of screening for GDM, although affordability remains to be assessed. In the current environment, screening for GDM in secondary care settings appears to be the better solution in consideration of cost-effectiveness.
AIMS/HYPOTHESIS: The aim of the study was to assess the cost-effectiveness of screening for gestational diabetes mellitus (GDM) in primary and secondary care settings, compared with a no-screening option, in the Republic of Ireland. METHODS: The analysis was based on a decision-tree model of alternative screening strategies in primary and secondary care settings. It synthesised data generated from a randomised controlled trial (screening uptake) and from the literature. Costs included those relating to GDM screening and treatment, and the care of adverse outcomes. Effects were assessed in terms of quality-adjusted life years (QALYs). The impact of the parameter uncertainty was assessed in a range of sensitivity analyses. RESULTS: Screening in either setting was found to be superior to no screening, i.e. it provided for QALY gains and cost savings. Screening in secondary care was found to be superior to screening in primary care, providing for modest QALY gains of 0.0006 and a saving of €21.43 per screened case. The conclusion held with high certainty across the range of ceiling ratios from zero to €100,000 per QALY and across a plausible range of input parameters. CONCLUSIONS/ INTERPRETATION: The results of this study demonstrate that implementation of universal screening is cost-effective. This is an argument in favour of introducing a properly designed and funded national programme of screening for GDM, although affordability remains to be assessed. In the current environment, screening for GDM in secondary care settings appears to be the better solution in consideration of cost-effectiveness.
Authors: Caroline A Crowther; Janet E Hiller; John R Moss; Andrew J McPhee; William S Jeffries; Jeffrey S Robinson Journal: N Engl J Med Date: 2005-06-12 Impact factor: 91.245
Authors: Patrick J Culligan; John A Myers; Roger P Goldberg; Linda Blackwell; Stephan F Gohmann; Troy D Abell Journal: Int Urogynecol J Pelvic Floor Dysfunct Date: 2004-07-29
Authors: Karl Horvath; Klaus Koch; Klaus Jeitler; Eva Matyas; Ralf Bender; Hilda Bastian; Stefan Lange; Andrea Siebenhofer Journal: BMJ Date: 2010-04-01
Authors: Mark B Landon; Catherine Y Spong; Elizabeth Thom; Marshall W Carpenter; Susan M Ramin; Brian Casey; Ronald J Wapner; Michael W Varner; Dwight J Rouse; John M Thorp; Anthony Sciscione; Patrick Catalano; Margaret Harper; George Saade; Kristine Y Lain; Yoram Sorokin; Alan M Peaceman; Jorge E Tolosa; Garland B Anderson Journal: N Engl J Med Date: 2009-10-01 Impact factor: 91.245
Authors: Eliana M Wendland; Maria Regina Torloni; Maicon Falavigna; Janet Trujillo; Maria Alice Dode; Maria Amélia Campos; Bruce B Duncan; Maria Inês Schmidt Journal: BMC Pregnancy Childbirth Date: 2012-03-31 Impact factor: 3.007
Authors: Neily Zakiyah; Robin Tuytten; Philip N Baker; Louise C Kenny; Maarten J Postma; Antoinette D I van Asselt Journal: PLoS One Date: 2022-04-21 Impact factor: 3.752