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

Abstract

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 $259 139 in India and $259 929 in Israel. Net costs, adjusted for averted disease, are $194 358 and $76 102, 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 $72 420–8432 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.

• Cost-effectiveness analysis
• costs
• diagnosis
• gestational diabetes mellitus
• management
• type 2 diabetes mellitus

Acknowledgements

We thank the following individuals for their thoughtful review and helpful suggestions on an early version of the cost-effectiveness model and the analytic approach we adopted: Jonathan Brown (International Diabetes Federation), Steven Chapman (Population Services International), Wolfgang Holzgreve (International Federation of Obstetricians and Gynecologists), Ashok Kumar Das (Jawaharlal Institute of Postgraduate Medical Education and Research), Anil Kapur (World Diabetes Foundation), Maria Inés Schimdt (Projeto ELSA-RS, UFRGS), Katia Skarbek (International Diabetes Federation) and Ping Zhang (US Centers for Disease Control and Prevention). We appreciate their generous collegiality. We would like to thank Dr Ashalata Srinivasan (CCMH) for her help in gathering caseload and cost data for the study. Our thanks also to Somya Gupta and Rajkumar Channabasavaiah for their able assistance in gathering and compiling cost and services data in India.