CERGAS (Centre for Research on Health and Social Care Management), Bocconi University, Via Roentgen 1, 20136, Milan, Italy.
Nestlé Research Center, Nestec SA, Route du Jorat 57, 1000, Lausanne, Switzerland.
BMC Pregnancy Childbirth. 2018 Feb 23;18(1):58. doi: 10.1186/s12884-018-1689-1.
The incidence of Gestational Diabetes Mellitus (GDM) is rising in all developed countries. This study aimed at assessing the short-term economic burden of GDM from the Italian healthcare system perspective.
A model was built over the last pregnancy trimester (i.e., from the 28th gestational week until childbirth included). The National Hospital Discharge Database (2014) was accessed to estimate delivery outcome probabilities and inpatient costs in GDM and normal pregnancies (i.e., euglycemia). International Classification of Disease-9th Revision-Clinical Modification (ICD9-CM) diagnostic codes and Diagnosis-Related Group (DRG) codes were used to identify GDM cases and different types of delivery (i.e., vaginal or cesarean) within the database. Neonatal outcomes probabilities were estimated from the literature and included macrosomia, hypoglycemia, hyperbilirubinemia, shoulder dystocia, respiratory distress, and brachial plexus injury. Additional data sources such as regional documents, official price and tariff lists, national statistics and expert opinion were used to populate the model. The average cost per case was calculated at national level to estimate the annual economic burden of GDM. One-way sensitivity analyses and Monte Carlo simulations were performed to quantify the uncertainty around base case results.
The amount of pregnancies complicated by GDM in Italy was assessed at 54,783 in 2014 using a prevalence rate of 10.9%. The antenatal outpatient cost per case was estimated at €43.7 in normal pregnancies compared to €370.6 in GDM patients, which is equivalent to a weighted sum of insulin- (14%; €1034.6) and diet- (86%; €262.5) treated women's costs. Inpatient delivery costs were assessed at €1601.6 and €1150.3 for euglycemic women and their infants, and at €1835.0 and €1407.7 for GDM women and their infants, respectively. Thus, the overall cost per case difference between GDM and normal pregnancies was equal to €817.8 (+ 29.2%), resulting in an economic burden of about €44.8 million in 2014 at national level. Probabilistic sensitivity analysis yielded a cost per case difference ranging between €464.9 and €1164.8 in 80% of simulations.
The economic burden of GDM in Italy is substantial even accounting for short-term medical costs only. Future research also addressing long-term consequences from a broader societal perspective is recommended.
在所有发达国家，妊娠糖尿病（GDM）的发病率都在上升。本研究旨在从意大利医疗保健系统的角度评估 GDM 的短期经济负担。
建立了一个模型，涵盖了最后一个妊娠 trimester（即从第 28 孕周到分娩包括在内）。访问了国家住院数据库（2014 年），以估计 GDM 和正常妊娠（即血糖正常）的分娩结局概率和住院费用。使用国际疾病分类第 9 版临床修订版（ICD9-CM）诊断代码和诊断相关组（DRG）代码在数据库中识别 GDM 病例和不同类型的分娩（即阴道分娩或剖宫产）。新生儿结局概率是从文献中估计的，并包括巨大儿、低血糖、高胆红素血症、肩难产、呼吸窘迫和臂丛神经损伤。使用区域文件、官方价格和关税清单、国家统计数据和专家意见等其他数据源来填充模型。以全国平均水平计算每个病例的平均成本，以估计 GDM 的年度经济负担。进行了单因素敏感性分析和蒙特卡罗模拟，以量化基本案例结果的不确定性。
2014 年，意大利 GDM 孕妇的数量为 54783 例，患病率为 10.9%。在正常妊娠中，每个病例的产前门诊费用估计为 43.7 欧元，而 GDM 患者为 370.6 欧元，这相当于胰岛素治疗（14%；1034.6 欧元）和饮食治疗（86%；262.5 欧元）女性成本的加权总和。正常孕妇及其婴儿的住院分娩费用估计为 1601.6 欧元，GDM 孕妇及其婴儿的住院分娩费用为 1150.3 欧元，GDM 孕妇及其婴儿的住院分娩费用分别为 1835.0 欧元和 1407.7 欧元。因此，GDM 和正常妊娠之间每个病例的总成本差异为 817.8 欧元（+29.2%），导致 2014 年全国层面经济负担约为 44.8 百万欧元。概率敏感性分析得出，80%的模拟中，每个病例的成本差异在 464.9 欧元至 1164.8 欧元之间。
即使仅考虑短期医疗费用，意大利 GDM 的经济负担也相当大。建议未来的研究还应从更广泛的社会角度解决长期后果。
