Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
Am J Obstet Gynecol. 2012 Oct;207(4):326.e1-9. doi: 10.1016/j.ajog.2012.06.048. Epub 2012 Jun 29.
This study investigates the cost effectiveness of gestational diabetes mellitus screening using the new International Association of Diabetes in Pregnancy Study Group (IADPSG) guidelines.
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.
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.
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.
本研究旨在探讨使用新的国际妊娠糖尿病研究组（IADPSG）指南进行妊娠期糖尿病筛查的成本效益。
建立了一个决策分析模型，比较了常规筛查与 2 小时口服葡萄糖耐量试验（2h OGTT）和 1 小时葡萄糖挑战试验。所有概率、成本和收益均来自文献。进行了基础案例、敏感性分析和蒙特卡罗模拟。
使用 2h OGTT 进行筛查的费用更高，但效果更好，每质量调整生命年的成本为 61503 美元。在单向敏感性分析中，只要有 2.0%或更多的患者被诊断并治疗妊娠期糖尿病，新的 IADPSG 诊断方法仍然具有成本效益。
在新的 IADPSG 指南下，在 24-28 孕周进行筛查，并采用 2h OGTT，虽然费用较高，但可改善母婴结局，具有成本效益。医疗保健系统将如何为这组女性提供扩大的护理服务，这将需要进行研究。
