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Fox HK, Callander EJ. Health service use and health system costs associated with diabetes during pregnancy in Australia. Nutr Metab Cardiovasc Dis 2021; 31:1427-1433. [PMID: 33846005 DOI: 10.1016/j.numecd.2021.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS In the context of the rising rate of diabetes in pregnancy in Australia, this study aims to examine the health service and resource use associated with diabetes during pregnancy. METHODS AND RESULTS This project utilised a linked administrative dataset containing health and cost data for all mothers who gave birth in Queensland, Australia between 2012 and 2015 (n = 186,789, plus their babies, n = 189,909). The association between maternal characteristics and diabetes status were compared with chi-square analyses. Multiple logistic regression produced the odds ratio of having different outcomes for women who had diabetes compared to women who did not. A two-sample t-test compared the mean number of health services accessed. Generalised linear regression produced the mean costs associated with health service use. Mothers who had diabetes during pregnancy were more likely to have their labour induced at <38 weeks gestation (OR:1.39, 95% CI:1.29-1.50); have a cesarean section (OR: 1.26, 95% CI:1.22-1.31); have a preterm birth (OR:1.24, 95%: 1.18-1.32); have their baby admitted to a Special Care Nursery (OR: 2.34, 95% CI:2.26-2.43) and a Neonatal Intensive Care Unit (OR:1.25, 95%CI: 1.14-1.37). On average, mothers with diabetes access health services on more occasions during pregnancy (54.4) compared to mothers without (50.5). Total government expenditure on mothers with diabetes over the first 1000 days of the perinatal journey was significantly higher than in mothers without diabetes ($12,757 and $11,332). CONCLUSION Overall, mothers that have diabetes in pregnancy require greater health care and resource use than mothers without diabetes in pregnancy.
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Affiliation(s)
- Haylee K Fox
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.
| | - Emily J Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Mo X, Gai Tobe R, Takahashi Y, Arata N, Liabsuetrakul T, Nakayama T, Mori R. Economic Evaluations of Gestational Diabetes Mellitus Screening: A Systematic Review. J Epidemiol 2021; 31:220-230. [PMID: 32448822 PMCID: PMC7878709 DOI: 10.2188/jea.je20190338] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aims to find evidence of the cost-effectiveness of gestational diabetes mellitus (GDM) screening and assess the quality of current economic evaluations, which have shown different conclusions with a variation in screening methods, data sources, outcome indicators, and implementation in diverse organizational contexts. METHODS Embase, Medline, Web of Science, Health Technology Assessment, database, and National Health Service Economic Evaluation Database databases were searched through June 2019. Studies on economic evaluation reporting both cost and health outcomes of GDM screening programs in English language were selected, and the quality of the studies was assessed using Drummond's checklist. The general characteristics, main assumptions, and results of the economic evaluations were summarized. RESULTS Our search yielded 10 eligible economic evaluations with different screening strategies compared in different settings and perspectives. The selected papers scored 81% (68-97%) on the items in Drummond's checklist on average. In general, a screening program is cost-effective or even dominant over no screening. The one-step screening, with more cases detected, is more likely to be cost-effective than the two-step screening. Universal screening is more likely to be cost-effective than screening targeting the high-risk population. Parameters affecting cost-effectiveness include: diagnosis criteria, epidemiological characteristics of the population, efficacy of screening and treatment, and costs. CONCLUSIONS Most studies found GDM screening to be cost-effective, though uncertainties remain due to many factors. The quality assessment identified weaknesses in the economic evaluations in terms of integrating existing data, measuring costs and consequences, analyzing perspectives, and adjusting for uncertainties.
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Affiliation(s)
- Xiuting Mo
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Ruoyan Gai Tobe
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Department of Empirical Social Security Research, National Institute of Population and Social Security Research, Tokyo, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Naoko Arata
- Division of Women’s Health and Reproductive Endocrinology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Abstract
Background: Prevalence of gestational diabetes mellitus (GDM) has increased steadily in recent years. Pregnant women with GDM are at risk for obstetrical and neonatal complications and require close multidisciplinary follow-up, which implies a significant use of hospital resources. Methods: A prospective noninferiority and controlled clinical trial was designed. The telehomecare (THCa) initiative is a clinical remote patient management project in women with GDM. The main objective was to evaluate the cost-effectiveness of THCa by assessing the direct costs, including the related reduction in medical visits. Secondary outcomes were to evaluate the impact of THCa on diabetes control, GDM-related complications, and patient satisfaction. Results: A total of 161 women were assigned to either an intervention group provided with a THCa system for transmission and online analysis of capillary glucose data (n = 80) or a control group receiving usual care in the clinic (n = 81). A decrease in medical visits by 56% (P < 0.001) in the THCa group was observed. There was no difference between the two groups in diabetes control or maternal and fetal complications. However, results showed a 10-fold increase in nursing interventions in THCa group (mainly by phone calls and e-mails). Satisfaction with care was high. Direct cost analysis revealed savings of 16% in patients followed by THCa compared with the control group. Conclusion: THCa monitoring significantly decreases medical visits and direct costs in GDM women without compromising pregnancy outcomes, quality of care, or patient satisfaction. THCa was shown to be cost-effective despite placing an additional burden on nursing time.
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Affiliation(s)
- Annie Lemelin
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Guy Paré
- Research Chair in Digital Health, HEC Montreal, Montreal, Canada
| | - Sophie Bernard
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Ariane Godbout
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
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Bailey C, Skouteris H, Teede H, Hill B, De Courten B, Walker R, Liew D, Thangaratinam S, Ademi Z. Are Lifestyle Interventions to Reduce Excessive Gestational Weight Gain Cost Effective? A Systematic Review. Curr Diab Rep 2020; 20:6. [PMID: 32008111 DOI: 10.1007/s11892-020-1288-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Lifestyle interventions (such as diet and physical activity) successfully limit excessive gestational weight gain and can reduce some adverse maternal events; however, benefit is variable and cost-effectiveness remains unclear. We aimed to review published cost-effectiveness analyses of lifestyle interventions compared with usual care on clinically relevant outcome measures. Five international and six grey-literature databases were searched from 2007 to 2018. Articles were assessed for quality of reporting. Data were extracted from healthcare and societal perspectives. Costs were adapted to the common currencies of Australia and the United Kingdom by adjusting for resource utilization, healthcare purchase price and changes in costs over time. Included studies were economic analyses of lifestyle interventions aiming to limit weight-gain during pregnancy and/or reduce risk of gestational diabetes, for women with a BMI of 25 or greater in pre- or early-pregnancy. RECENT FINDINGS Of the 538 articles identified, six were retained for review: one modelling study and five studies in which an economic analysis was performed alongside a randomized-controlled trial. Outcome measures included infant birth-weight, fasting glucose, insulin resistance, gestational weight-gain, infant respiratory distress syndrome, perceived health, cost per case of adverse outcome avoided and quality-adjusted life years (QALYs). Interventions were cost-effective in only one study. Although many studies have investigated the efficacy of lifestyle interventions in pregnancy, few have included cost-effectiveness analyses. Where cost-effectiveness studies were undertaken, results were inconsistent. Secondary meta-analysis, taxonomy and framework research is now required to determine the effective components of lifestyle interventions and to guide future cost-effectiveness analyses.
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Affiliation(s)
- Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Monash Centre for Health Research and Implementation, Monash University, Level 1 42-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Barbora De Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ruth Walker
- Monash Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Abstract
PURPOSE OF REVIEW Currently, the diagnosis of gestational diabetes mellitus (GDM) lacks uniformity. Several controversies are still under debate, especially on the method of screening and diagnosis. This review focuses on recent literature and provides current evidence for the screening and diagnosis of GDM. RECENT FINDINGS Selective screening would miss a significant number of women with GDM. In contrast, universal screening has been shown to be cost-effective, compared with selective screening, and is recommended by many medical societies. For the diagnostic methods for GDM, most observational cohort studies reported that the one-step method is associated with improved pregnancy outcomes and is cost-saving or cost-effective, compared with the two-step method, although these findings should be confirmed in the upcoming randomized controlled trials which compare the performance of one-step and two-step methods. On the other hand, the methods of early screening or diagnosis of GDM are varied, and current evidence does not justify their use during early pregnancy. In conclusion, current evidence favors universal screening for GDM using the one-step method. Early screening for GDM is not favorably supported by the literature.
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Affiliation(s)
- Chun-Heng Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
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He Z, Xie H, Liang S, Tang Y, Ding W, Wu Y, Ming W. Influence of different diagnostic criteria on gestational diabetes mellitus incidence and medical expenditures in China. J Diabetes Investig 2019; 10:1347-1357. [PMID: 30663279 PMCID: PMC6717806 DOI: 10.1111/jdi.13008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/27/2022] Open
Abstract
AIMS/INTRODUCTION To summarize the development of the criteria for diagnosing gestational diabetes mellitus (GDM) in China, and investigate how different GDM diagnostic criteria influence the national prevalence of GDM, the national health system and the economic burden of GDM in China. MATERIALS AND METHODS Retrospectively using data from women undergoing a 2-h, 75-g oral glucose tolerance test at 24-28 gestational weeks in the First Affiliated Hospital of Jinan University (Guangzhou, Guangdong, China) from January 2011 to December 2017, the prevalence rate of GDM and its impacts on the national health system were evaluated using different criteria (the 7th edition textbook criteria, National Diabetes Data Group 1979, World Health Organization 1985, European Association for the Study of Diabetes 1996, Japan 2002, American Diabetes Association [ADA] 2011 [International Association of the Diabetes and Pregnancy Study Groups], and National Institute for Heath and Care Excellence 2015). RESULTS The incidence rates of GDM based on the ADA 2011 and National Institute for Heath and Care Excellence 2015 were, respectively, 22.94% (P < 0.01) and 21.72% (P < 0.01), over threefold higher than implementing the 7th edition textbook criteria (P < 0.001). On the contrary, the incidence rates of GDM diagnosed with the National Diabetes Data Group 1979 and World Health Organization 1985 guidelines were significantly less than the 7th edition textbook criteria (P < 0.001). From 2001 to 2016, the estimated national cost of treating GDM rose from ¥3.9 billion to ¥27.4 billion after implementing the ADA 2011 guidelines. CONCLUSIONS With the implementation of ADA 2011 (International Association of the Diabetes and Pregnancy Study Groups) guidelines, there are fewer adverse perinatal outcomes and cases of type 2 diabetes mellitus in the long term, but the medical costs increased significantly, and the cost-effectiveness of diagnostic criteria in China is still yet to be confirmed.
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Affiliation(s)
- Zonglin He
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Faculty of MedicineInternational SchoolJinan UniversityGuangzhouChina
| | - Huatao Xie
- Faculty of MedicineInternational SchoolJinan UniversityGuangzhouChina
| | - Shangqiang Liang
- Faculty of MedicineInternational SchoolJinan UniversityGuangzhouChina
| | - Yuan Tang
- Faculty of MedicineInternational SchoolJinan UniversityGuangzhouChina
| | - Wenjing Ding
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Yanxin Wu
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Wai‐kit Ming
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Faculty of MedicineInternational SchoolJinan UniversityGuangzhouChina
- Harvard Medical SchoolHarvard UniversityBostonMassachusettsUSA
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Sosa-Rubi SG, Dainelli L, Silva-Zolezzi I, Detzel P, Espino Y Sosa S, Reyes-Muñoz E, Chivardi C, Ortiz-Panozo E, Lopez-Ridaura R. Short-term health and economic burden of gestational diabetes mellitus in Mexico: A modeling study. Diabetes Res Clin Pract 2019; 153:114-124. [PMID: 31108135 DOI: 10.1016/j.diabres.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
AIM To estimate the annual burden of gestational diabetes mellitus (GDM) in Mexico. METHODS A model was built to conduct estimates from a healthcare system perspective, namely, the incremental costs of GDM pregnancy compared with non-GDM pregnancy from the first trimester until childbirth. The model used probabilities from the literature and surveys, and costs obtained from the Ministry of Health and national healthcare institutions. Scenario analyses were performed to estimate the GDM burden at different levels of incidence. RESULTS Although a non-GDM pregnancy cost on average USD 1880.6 (low risk was USD 1043.9 and high risk was USD 1673.5), a pregnancy with GDM cost USD 2934.9. Therefore, the total additional cost was USD 1576.2 per case. Given the considerable variability of the GDM incidence in Mexico, the total burden could range from USD 86.8 to USD 827.4 million per year. CONCLUSIONS GDM is one of the most frequent complications of pregnancy, but research has been insufficient regarding its epidemiological and economic burden in Latin America. This paper shows that the GDM economic burden in Mexico is substantial despite only accounting for short-term medical costs. Further research to assess the GDM incidence and evaluate its long-term consequences from a broader societal perspective in Mexico is recommended.
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Affiliation(s)
| | | | | | | | - Salvador Espino Y Sosa
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes Ciudad de México, CDMX, Mexico
| | - Enrique Reyes-Muñoz
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes Ciudad de México, CDMX, Mexico
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Fitria N, van Asselt ADI, Postma MJ. Cost-effectiveness of controlling gestational diabetes mellitus: a systematic review. Eur J Health Econ 2019; 20:407-417. [PMID: 30229375 PMCID: PMC6438940 DOI: 10.1007/s10198-018-1006-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Timely screening for hyperglycaemia in pregnancy using a simple glucose test enhances early detection and control of gestational diabetes mellitus (GDM). The aim of this study was to provide an overview of the evidence on the cost-effectiveness of identification and/or treatment of GDM. METHODS We conducted a systematic review using three electronic databases (PubMed, EMBASE, and Cochrane) of cost-effectiveness studies of GDM screening and treatment published during 2000-2017. RESULTS The initial search discovered 287 references (PubMed 86, EMBASE 195, Cochrane library 6) of which six full articles were included in the review. Two articles were model-based analysis and the remaining four were trial based. Two studies demonstrated favorable cost-effectiveness of intensified management of mild GDM. In the other included studies, neither screening nor treatment of GDM was shown to be cost effective, although results varied with the particular outcome measures used and the assumptions that where applied. CONCLUSION Neither screening nor treating GDM seems to be convincingly cost-effective from the studies reviewed. However, all studies were done in high-income countries with obviously different health systems than low-/middle-income countries (LMIC) have. Since detection of GDM may be relatively poor in LMIC, screening might be more worthwhile in these countries. Comprehensive research is necessary in LMIC, including the potential outcomes of assessing its cost-effectiveness. Favorable cost-effectiveness could help in bridging the need for and access to increased diabetes screening in early pregnancy in these countries.
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Affiliation(s)
- Najmiatul Fitria
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, A.Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
- Unit of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Andalas, Padang, West Sumatra, Indonesia.
| | - Antoinette D I van Asselt
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, A.Deusinglaan 1, 9713 AV, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, A.Deusinglaan 1, 9713 AV, Groningen, The Netherlands
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Rönö K, Masalin S, Kautiainen H, Gissler M, Raina M, Eriksson JG, Laine MK. Impact of maternal income on the risk of gestational diabetes mellitus in primiparous women. Diabet Med 2019; 36:214-220. [PMID: 30307050 DOI: 10.1111/dme.13834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 12/23/2022]
Abstract
AIMS Findings concerning the impact of socio-economic status on the risk of gestational diabetes mellitus (GDM) are inconclusive and little is known about the simultaneous impact of income and educational attainment on the risk of GDM. This study aims to assess the impact of maternal prepregnancy income in combination with traditional GDM risk factors on the incidence of GDM in primiparous women. METHODS This is an observational cohort study including 5962 Finnish women aged ≥ 20 years from the city of Vantaa, Finland, who delivered for the first time between 2009 and 2015, excluding women with pre-existing diabetes mellitus. The Finnish Medical Birth Register, Finnish Tax Administration, Statistics Finland, Social Insurance Institution of Finland and patient healthcare records provided data for the study. We divided the study population according to five maternal income levels and four educational attainment levels. RESULTS Incidence of GDM decreased with increasing income level in primiparous women (P < 0.001 for linearity, adjusted for smoking, age, BMI and cohabiting status). In an adjusted two-way model, the relationship was significant for both income (P = 0.007) and education (P = 0.039), but there was no interaction between income and education (P = 0.52). CONCLUSIONS There was an inverse relationship between both maternal prepregnancy taxable income and educational attainment, and the risk of GDM in primiparous Finnish women.
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Affiliation(s)
- K Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Masalin
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Kautiainen
- Folkhälsan Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - M Gissler
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - M Raina
- Vantaa Health Centre, Vantaa, Finland
- Apotti, Helsinki, Finland
| | - J G Eriksson
- Folkhälsan Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - M K Laine
- Folkhälsan Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Vantaa Health Centre, Vantaa, Finland
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10
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Abstract
OBJECTIVE To identify effects on health outcomes from implementing new criteria diagnosing gestational diabetes mellitus(GDM) and to analyse costs-of-care associated with this change. DESIGN Quasi-experimental study comparing data from the calendar year before (2014) and after (2016) the change. SETTING Single, tertiary-level, university-affiliated, maternity hospital. PARTICIPANTS All women giving birth in the hospital, excluding those with pre-existing diabetes or multiple pregnancy. MAIN OUTCOME MEASURES Primary outcomes were caesarean section, birth weight >90th percentile for gestation, hypertensive disorder of pregnancy and preterm birth less than 37 weeks. A number of secondary outcomes reported to be associated with GDM were also analysed.Care packages were derived for those without GDM, diet-controlled GDM and GDM requiring insulin. The institutional Business Reporting Unit data for average occasions of service, pharmacy schedule for the costs of consumables and medications, and Medicare Benefits Schedule ultrasound services were used for costing each package. All costs were estimated in figures from the end of 2016 negating the need to adjust for Consumer Price Index increases. RESULTS There was an increase in annual incidence of GDM of 74% without overall improvements in primary health outcomes. This incurred a net cost increase of AUD$560 093. Babies of women with GDM had lower rates of neonatal hypoglycaemia and special care nursery admissions after the change, suggesting a milder spectrum of disease. CONCLUSION New criteria for the diagnosis of GDM have increased the incidence of GDM and the overall cost of GDM care. Without obvious changes in short-term outcomes, validation over other systems of diagnosis may require longer term studies in cohorts using universal screening and treatment under these criteria.
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Affiliation(s)
- Thomas J Cade
- Diabetes Service, Royal Women's Hospital, Parkville, Victoria, Australia
- Pregnancy Research Service, Department of Maternal Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Alexander Polyakov
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Department of Reproductive Biology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Shaun P Brennecke
- Pregnancy Research Service, Department of Maternal Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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Werbrouck A, Schmidt M, Putman K, Benhalima K, Verhaeghe N, Annemans L, Simoens S. A systematic review on costs and cost-effectiveness of screening and prevention of type 2 diabetes in women with prior gestational diabetes: Exploring uncharted territory. Diabetes Res Clin Pract 2019; 147:138-148. [PMID: 30529576 DOI: 10.1016/j.diabres.2018.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/27/2018] [Accepted: 11/21/2018] [Indexed: 01/20/2023]
Abstract
AIMS Women with gestational diabetes mellitus (GDM) are more likely to develop type 2 diabetes mellitus (T2DM) as compared to women with normoglycemic pregnancies. This study aims to explore the literature on cost(-effectiveness) of screening and prevention of T2DM in women with prior GDM. METHODS Five databases were systematically searched, inclusion criteria were: (1) women with (prior) GDM; (2) post-partum screening or prevention of T2DM; and (3) health-economic evaluations. No year limits were applied. English, Dutch, French or German publications were included. Quality was assessed using the Consensus Health Economic Criteria checklist. RESULTS Two cost-effectiveness analyses and two cost analyses were found. One study evaluated nine screening strategies. Three studies evaluated one prevention strategy each: intensive diet and behavioural modification; annual counseling; and an annual dietary consultation. Methodological quality was poor. Perspectives were unclear, time horizons were too short, and no incremental analyses were performed. CONCLUSION An oral glucose tolerance test per three years leads to the lowest cost per case detected, and prevention is potentially cost-effective or cost-saving. More health economic evaluations are needed that compare all relevant alternatives, including 'doing nothing'.
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Affiliation(s)
- Amber Werbrouck
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, De Pintelaan 185, 9000 Gent, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2 bus 521, Herestraat 49, 3000 Leuven, Belgium.
| | - Masja Schmidt
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium
| | - Koen Putman
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, De Pintelaan 185, 9000 Gent, Belgium; Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, De Pintelaan 185, 9000 Gent, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2 bus 521, Herestraat 49, 3000 Leuven, Belgium
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Emeruwa UN, Zera C. Optimal Obstetric Management for Women with Diabetes: the Benefits and Costs of Fetal Surveillance. Curr Diab Rep 2018; 18:96. [PMID: 30194499 DOI: 10.1007/s11892-018-1058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To elaborate on the risks and benefits associated with antenatal fetal surveillance for stillbirth prevention in women with diabetes. RECENT FINDINGS Women with pregestational diabetes have a 3- to 5-fold increased odds of stillbirth compared to women without diabetes. The stillbirth risk in women with gestational diabetes (GDM) is more controversial; while recent data suggest the odds for stillbirth are approximately 50% higher in women with GDM at term (37 weeks and beyond) than in those without GDM, it is unclear if this risk is seen in women with optimal glycemic control. Current professional society guidelines are broad with respect to fetal testing strategies and delivery timing in women with diabetes. The data supporting strategies to reduce the risk of stillbirth in women with diabetes are limited. Antepartum fetal surveillance should be performed to reduce stillbirth rates; however, the optimal test, frequency of testing, and delivery timing are not yet clear. Future studies of obstetric management for women with diabetes should consider not just individual but also system level costs and benefits associated with antenatal surveillance.
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Affiliation(s)
- Ukachi N Emeruwa
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, ASB 1-3, Boston, MA, 02115, USA.
| | - Chloe Zera
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
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Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) is associated with a higher risk for adverse health outcomes during pregnancy and delivery for both mothers and babies. This study aims to assess the short-term health and economic burden of GDM in China in 2015. DESIGN Using TreeAge Pro, an analytical decision model was built to estimate the incremental costs and quality-of-life loss due to GDM, in comparison with pregnancy without GDM from the 28th gestational week until and including childbirth. The model was populated with probabilities and costs based on current literature, clinical guidelines, price lists and expert interviews. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results. PARTICIPANTS Chinese population who gave birth in 2015. RESULTS On average, the cost of a pregnancy with GDM was ¥6677.37 (in 2015 international $1929.87) more (+95%) than a pregnancy without GDM, due to additional expenses during both the pregnancy and delivery: ¥4421.49 for GDM diagnosis and treatment, ¥1340.94 (+26%) for the mother's complications and ¥914.94 (+52%) for neonatal complications. In China, 16.5 million babies were born in 2015. Given a GDM prevalence of 17.5%, the number of pregnancies affected by GDM was estimated at 2.90 million in 2015. Therefore, the annual societal economic burden of GDM was estimated to be ¥19.36 billion (international $5.59 billion). Sensitivity analyses were used to confirm the robustness of the results. Incremental health losses were estimated to be approximately 260 000 quality-adjusted life years. CONCLUSION In China, the GDM economic burden is significant, even in the short-term perspective and deserves more attention and awareness. Our findings indicate a clear need to implement GDM prevention and treatment strategies at a national level in order to reduce the economic and health burden at both the population and individual levels.
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Affiliation(s)
- Tingting Xu
- China Center for Health Development Studies, Peking University, Beijing, China
| | | | - Kai Yu
- Consumer Research & Public Health, Nestlé Research Center, Beijing, China
| | - Liangkun Ma
- Peking Union MedicalCollege Hospital, Beijing, China
| | | | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
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Capula C, Chiefari E, Borelli M, Oliverio R, Vero A, Foti D, Puccio L, Vero R, Brunetti A. A new predictive tool for the early risk assessment of gestational diabetes mellitus. Prim Care Diabetes 2016; 10:315-323. [PMID: 27268754 DOI: 10.1016/j.pcd.2016.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/06/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
AIMS The Italian National Institute of Health has recently introduced a selective screening based on the risk profile of pregnant women, which while recommending against screening of women at low risk (LR) for GDM, it recommends an early test for women at high risk (HR) for GDM. Herein, we assessed the accuracy and cost-effectiveness of this screening and developed a new index that improves these requirements. METHODS We retrospectively enrolled 3974 pregnant women. GDM was diagnosed with a 2h 75-g OGTT at 16-18 weeks (early test) or 24-28 weeks of gestation, according to the IADPSG guidelines. RESULTS 55.6% of HR women had GDM, although only 38.4% underwent early screening. Among 2654 women at medium risk, 20.9% had GDM; paradoxically, among 770 LR women, that would not have been screened, 26.6% received a GDM diagnosis. Based on these unsatisfactory results, we elaborated the Capula's index, that reduced both screening tests (p<0.001) and potentially undetected GDM cases (p<0.001), and corrected the paradoxical prevalence estimates of GDM obtained with the current Italian guidelines. Also, Capula's index improved correlation of GDM risk profile with obstetric and neonatal adverse events. CONCLUSIONS Capula's index improves accuracy of selective screening for GDM.
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Affiliation(s)
- Carmelo Capula
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Massimo Borelli
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy
| | - Rosa Oliverio
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Anna Vero
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Daniela Foti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Luigi Puccio
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Raffaella Vero
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
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Danyliv A. Response to Dr. Coustan: Costs of gestational diabetes (comment on Danyliv, A. et al. Short- and long-term effects of gestational diabetes mellitus on healthcare cost: a cross-sectional comparative study in the ATLANTIC DIP cohort). Diabet Med 2016; 33:851-2. [PMID: 26337057 DOI: 10.1111/dme.12954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A Danyliv
- School of Business and Economics, National University of Ireland Galway, Galway, Ireland
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16
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Coustan DR. Costs of gestational diabetes. Diabet Med 2016; 33:852-3. [PMID: 26361358 DOI: 10.1111/dme.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- D R Coustan
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Women & Infants Hospital of Rhode Island, Providence, RI, USA
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17
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Mohan MA, Chandrakumar A. Evaluation of prevalence and risk factors of gestational diabetes in a tertiary care hospital in Kerala. Diabetes Metab Syndr 2016; 10:68-71. [PMID: 26476488 DOI: 10.1016/j.dsx.2015.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
Abstract
AIMS The prospective study was conducted with the aim to evaluate the prevalence and risk factors of gestational diabetes mellitus in a tertiary care referral hospital in Kerala. MATERIALS AND METHODS A prospective observational study was conducted with the aim to study the prevalence, risk factors, complications, treatment pattern and cost analysis of GDM. The study was carried out in the Obstetrics & Gynecology dDepartment of Al Shifa hHospital located in northern Kerala. RESULTS Over an eight-month period, 201 patients who met the inclusion criteria were enrolled for study from which prevalence of GDM was estimated at 15.9%. The study revealed higher prevalence of risk factors and complications such as age >25 years, BMI >26kg/m(2), family history of DM, past history GDM, history of big baby, gestational hypertension, vaginal candidiasis, premature rupture of membranes and hyperbilirubinemia in GDM group as compared to non-GDM group. The study also demonstrated that modern life-style was a major influencing factor for development of diabetes in the study population. CONCLUSION The study reveals the necessity of proper screening diagnosis and management of GDM in pregnant women by the clinicians so as to prevent the future burden of type 2 diabetes.
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Affiliation(s)
- Manju A Mohan
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Kizhattur, Poonthavanam P.O, Perinthalmanna 679322, Kerala, India.
| | - Abin Chandrakumar
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Kizhattur, Poonthavanam P.O, Perinthalmanna 679322, Kerala, India.
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18
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Zheng ASY, O'Leary T, Moses R. Gestational diabetes mellitus and life assurance: the United Kingdom perspective. Diabet Med 2016; 33:406. [PMID: 26059218 DOI: 10.1111/dme.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Affiliation(s)
- A S Y Zheng
- Endocrinology and Diabetes, Wollongong Hospital, Wollongong
| | - T O'Leary
- Australian Life Underwriters and Claims Association, Sydney
| | - R Moses
- Illawarra Diabetes Service and Clinical Trials and Research Unit, Wollongong, Australia
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19
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Danyliv A, Gillespie P, O'Neill C, Tierney M, O'Dea A, McGuire BE, Glynn LG, Dunne FP. The cost-effectiveness of screening for gestational diabetes mellitus in primary and secondary care in the Republic of Ireland. Diabetologia 2016; 59:436-44. [PMID: 26670162 DOI: 10.1007/s00125-015-3824-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/10/2015] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Andriy Danyliv
- J. E. Cairnes School of Business and Economics, National University of Ireland Galway, H91TK33, Galway, Ireland.
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.
| | - Paddy Gillespie
- J. E. Cairnes School of Business and Economics, National University of Ireland Galway, H91TK33, Galway, Ireland
| | - Ciaran O'Neill
- J. E. Cairnes School of Business and Economics, National University of Ireland Galway, H91TK33, Galway, Ireland
| | - Marie Tierney
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Angela O'Dea
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Brian E McGuire
- Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Liam G Glynn
- Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Fidelma P Dunne
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland
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20
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Bhavadharini B, Mahalakshmi MM, Maheswari K, Kalaiyarasi G, Anjana RM, Deepa M, Ranjani H, Priya M, Uma R, Usha S, Pastakia SD, Malanda B, Belton A, Unnikrishnan R, Kayal A, Mohan V. Use of capillary blood glucose for screening for gestational diabetes mellitus in resource-constrained settings. Acta Diabetol 2016; 53:91-7. [PMID: 25916215 PMCID: PMC4749644 DOI: 10.1007/s00592-015-0761-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/12/2015] [Indexed: 12/17/2022]
Abstract
AIMS The aim of the study was to evaluate usefulness of capillary blood glucose (CBG) for diagnosis of gestational diabetes mellitus (GDM) in resource-constrained settings where venous plasma glucose (VPG) estimations may be impossible. METHODS Consecutive pregnant women (n = 1031) attending antenatal clinics in southern India underwent 75-g oral glucose tolerance test (OGTT). Fasting, 1- and 2-h VPG (AU2700 Beckman, Fullerton, CA) and CBG (One Touch Ultra-II, LifeScan) were simultaneously measured. Sensitivity and specificity were estimated for different CBG cut points using the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for the diagnosis of GDM as gold standard. Bland-Altman plots were drawn to look at the agreement between CBG and VPG. Correlation and regression equation analysis were also derived for CBG values. RESULTS Pearson's correlation between VPG and CBG for fasting was r = 0.433 [intraclass correlation coefficient (ICC) = 0.596, p < 0.001], for 1H, it was r = 0.653 (ICC = 0.776, p < 0.001), and for 2H, r = 0.784 (ICC = 0.834, p < 0.001). Comparing a single CBG 2-h cut point of 140 mg/dl (7.8 mmol/l) with the IADPSG criteria, the sensitivity and specificity were 62.3 and 80.7 %, respectively. If CBG cut points of 120 mg/dl (6.6 mmol/l) or 110 mg/dl (6.1 mmol/l) were used, the sensitivity improves to 78.3 and 92.5 %, respectively. CONCLUSIONS In settings where VPG estimations are not possible, CBG can be used as an initial screening test for GDM, using lower 2H CBG cut points to maximize the sensitivity. Those who screen positive can be referred to higher centers for definitive testing, using VPG.
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Affiliation(s)
- Balaji Bhavadharini
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Manni Mohanraj Mahalakshmi
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Kumar Maheswari
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Gunasekaran Kalaiyarasi
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Mohan Deepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Harish Ranjani
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Miranda Priya
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ram Uma
- Seethapathy Clinic and Hospital, Chennai, India
| | - Sriram Usha
- Associates in Clinical Endocrinology Education and Research (ACEER), Chennai, India
| | | | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- International Diabetes Federation, Brussels, Belgium
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
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Whiteman VE, Salemi JL, Mejia De Grubb MC, Ashley Cain M, Mogos MF, Zoorob RJ, Salihu HM. Additive effects of Pre-pregnancy body mass index and gestational diabetes on health outcomes and costs. Obesity (Silver Spring) 2015; 23:2299-308. [PMID: 26390841 DOI: 10.1002/oby.21222] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/11/2015] [Accepted: 06/19/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Pre-pregnancy obesity and gestational diabetes mellitus (GDM) are increasingly prevalent independent risk factors for maternal and infant morbidities. However, there is a paucity of information on their joint effects on health outcomes and healthcare costs. METHODS A population-based retrospective cohort study was conducted in Florida using a validated statewide database covering 1,057,647 infants born between 2004 and 2009. Using generalized linear modeling, joint associations between levels of pre-pregnancy body mass index (BMI) and GDM and maternal complications of pregnancy, adverse birth outcomes, and healthcare costs were examined. The relative excess risk due to interaction was used to describe the direction and magnitude of the BMI-GDM interaction on the additive scale. RESULTS Increasing pre-pregnancy BMI conferred increasing odds of adverse consequences, as did GDM, and the BMI-GDM interaction was greater than additive for 9 of 14 outcomes. The cost for infants born to women with GDM/obesity-III was 34% higher during the first year compared with those born to women with normal BMI and without GDM. The costs of maternal and infant inpatient care associated with overweight/obesity and GDM totaled over $351 million. CONCLUSIONS These findings provide further evidence of the importance of lifestyle modifications to decrease rates of obesity and risk factors from GDM.
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Affiliation(s)
- Valerie E Whiteman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Maria C Mejia De Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mary Ashley Cain
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Mulubrhan F Mogos
- Department of Community and Health Systems, School of Nursing, University of Indiana, Indianapolis, Indiana, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hamisu M Salihu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
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22
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Jovanovič L, Liang Y, Weng W, Hamilton M, Chen L, Wintfeld N. Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy. Diabetes Metab Res Rev 2015; 31:707-16. [PMID: 25899622 PMCID: PMC4676929 DOI: 10.1002/dmrr.2656] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 04/15/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increasing diabetes prevalence affects a substantial number of pregnant women in the United States. Our aims were to evaluate health outcomes, medical costs, risks and types of complications associated with diabetes in pregnancy for mothers and newborns. METHODS In this retrospective claims analysis, patients were identified from the Truven Health MarketScan(®) database (2004-2011 inclusive). Participants were aged 18-45 years, with ascertainable diabetes status [Yes/No], date of birth event >2005 and continuous health plan enrolment ≥21 months before and 3 months after the birth. RESULTS In total, 839 792 pregnancies were identified, and 66 041 (7.86%) were associated with diabetes mellitus [type 1 (T1DM), 0.13%; type 2 (T2DM), 1.21%; gestational (GDM), 6.29%; and GDM progressing to T2DM (patients without prior diabetes who had a T2DM diagnosis after the birth event), 0.23%]. Relative risk (RR) of stillbirth (2.51), miscarriage (1.28) and Caesarean section (C-section) (1.77) was significantly greater with T2DM versus non-diabetes. Risk of C-section was also significantly greater for other diabetes types [RR 1.92 (T1DM); 1.37 (GDM); 1.63 (GDM progressing to T2DM)]. Risk of overall major congenital (RR ≥ 1.17), major congenital circulatory (RR ≥ 1.19) or major congenital heart (RR ≥ 1.18) complications was greater in newborns of mothers with diabetes versus without. Mothers with T2DM had significantly higher risk (RR ≥ 1.36) of anaemia, depression, hypertension, infection, migraine, or cardiac, obstetrical or respiratory complications than non-diabetes patients. Mean medical costs were higher with all diabetes types, particularly T1DM ($27 531), than non-diabetes ($14 355). CONCLUSIONS Complications and costs of healthcare were greater with diabetes, highlighting the need to optimize diabetes management in pregnancy.
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MESH Headings
- Abortion, Spontaneous/economics
- Abortion, Spontaneous/epidemiology
- Adolescent
- Adult
- Anemia/economics
- Anemia/epidemiology
- Cesarean Section/economics
- Cesarean Section/statistics & numerical data
- Congenital Abnormalities/economics
- Congenital Abnormalities/epidemiology
- Depression/economics
- Depression/epidemiology
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes, Gestational/economics
- Diabetes, Gestational/epidemiology
- Female
- Health Care Costs
- Heart Defects, Congenital/economics
- Heart Defects, Congenital/epidemiology
- Humans
- Incidence
- Infant, Newborn
- Middle Aged
- Pregnancy
- Pregnancy Complications, Cardiovascular/economics
- Pregnancy Complications, Cardiovascular/epidemiology
- Pregnancy Complications, Hematologic/economics
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Infectious/economics
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Outcome/economics
- Pregnancy Outcome/epidemiology
- Pregnancy in Diabetics/economics
- Pregnancy in Diabetics/epidemiology
- Retrospective Studies
- Stillbirth/economics
- Stillbirth/epidemiology
- United States
- Young Adult
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Affiliation(s)
- Lois Jovanovič
- Sansum Diabetes Research InstituteSanta Barbara, CA, USA
- * Correspondence to: Lois Jovanovič, Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA, 93105 USA., E-mail:
| | | | | | | | - Lisa Chen
- Novo Nordisk Inc.Plainsboro, NJ, USA
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23
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Bardenheier BH, Imperatore G, Gilboa SM, Geiss LS, Saydah SH, Devlin HM, Kim SY, Gregg EW. Trends in Gestational Diabetes Among Hospital Deliveries in 19 U.S. States, 2000-2010. Am J Prev Med 2015; 49:12-9. [PMID: 26094225 PMCID: PMC4532269 DOI: 10.1016/j.amepre.2015.01.026] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/23/2015] [Accepted: 01/30/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Diabetes is one of the most common and fastest-growing comorbidities of pregnancy. Temporal trends in gestational diabetes mellitus (GDM) have not been examined at the state level. This study examines GDM prevalence trends overall and by age, state, and region for 19 states, and by race/ethnicity for 12 states. Sub-analysis assesses trends among GDM deliveries by insurance type and comorbid hypertension in pregnancy. METHODS Using the Agency for Healthcare Research and Quality's National and State Inpatient Databases, deliveries were identified using diagnosis-related group codes for GDM and comorbidities using ICD-9-CM diagnosis codes among all community hospitals. General linear regression with a log-link and binomial distribution was used in 2014 to assess annual change in GDM prevalence from 2000 through 2010. RESULTS The age-standardized prevalence of GDM increased from 3.71 in 2000 to 5.77 per 100 deliveries in 2010 (relative increase, 56%). From 2000 through 2010, GDM deliveries increased significantly in all states (p<0.01), with relative increases ranging from 36% to 88%. GDM among deliveries in 12 states reporting race and ethnicity increased among all groups (p<0.01), with the highest relative increase in Hispanics (66%). Among GDM deliveries in 19 states, those with pre-pregnancy hypertension increased significantly from 2.5% to 4.1% (relative increase, 64%). The burden of GDM delivery payment shifted from private insurers (absolute decrease of 13.5 percentage points) to Medicaid/Medicare (13.2-percentage point increase). CONCLUSIONS Results suggest that GDM deliveries are increasing. The highest rates of increase are among Hispanics and among GDM deliveries complicated by pre-pregnancy hypertension.
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Affiliation(s)
- Barbara H Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion.
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Suzanne M Gilboa
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Linda S Geiss
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Sharon H Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Heather M Devlin
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Shin Y Kim
- Division for Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
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Abstract
OBJECTIVE To compare the cost-effectiveness of 2 possible screening strategies for gestational diabetes mellitus (GDM) from the perspective of the New Zealand health system, developed as part of a gestational diabetes guideline. DESIGN A decision analytic model was built comparing 2-step screening (glycated haemoglobin (HbA1c) test at first booking and a 2 h 75 g oral glucose tolerance test (OGTT) as a single test at 24-28 weeks) with 3-step screening (HbA1c test at first booking and a 1 h glucose challenge test (GCT) followed by a 2 h 75 g OGTT when indicated from 24-28 weeks) using a 9-month time horizon. SETTING A hypothetical cohort of 62,000 pregnant women in New Zealand. METHODS Probabilities, costs and benefits were derived from the literature, and supplementary data was obtained from National Women's Annual Clinical Reports. Main outcome measures, screening and treatment costs (NZ$2013) and effect on health outcomes (incidence of complications). RESULTS The total cost for both strategies under baseline assumptions shows that the 2-step screening strategy would cost NZ$1.38 m more than the 3-step screening strategy overall. The additional cost per case detected was NZ$12,460 per case. The model found that the 2-step screening strategy identifies 12 more women with diabetes and 111 more women with GDM when compared against the 3-step screening strategy. We assessed the effect of changing the sensitivity and specificity of the OGTT. The baseline model assumed that the 2 h 75 g OGTT has a sensitivity and specificity of 95%. The 2-step strategy becomes more cost-effective when the diagnostic accuracy measures are improved. CONCLUSIONS Adopting a 2-step strategy would moderately increase the number of GDM cases detected at the same time as moderately increasing the number of women with false negatives at a significant cost to the health system. Further evidence on the benefits of the 2 different approaches would be welcome.
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Affiliation(s)
- Catherine Coop
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Richard Edlin
- Department of Health Systems, University of Auckland, Auckland, New Zealand
| | - Julie Brown
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Cindy Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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Nuzback K. A Heavy Burden. Tex Med 2015; 111:51-55. [PMID: 26047520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A Texas Health and Human Services Commission report reveals gestational diabetes mellitus (GDM) and obese mothers take a toll on the state's Medicaid program. According to the report, in Medicaid, the excess medical and drug costs among women with GDM and their babies totaled $10 million. Women with pregestational diabetes cost Medicaid $60 million more than nondiabetic, normal-weight women. Much of the cost associated with diabetes and obesity comes from more frequent hospitalizations for the mother and a higher likelihood the infant will be admitted into the neonatal intensive care unit.
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Durán Rodriguez-Hervada A, Calle Pascual AL. Diagnostic criteria for gestational diabetes: The debate goes on. Endocrinol Nutr 2015; 62:207-209. [PMID: 25842036 DOI: 10.1016/j.endonu.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/16/2015] [Indexed: 06/04/2023]
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Son KH, Lim NK, Lee JW, Cho MC, Park HY. Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes. Diabet Med 2015; 32:477-86. [PMID: 25472691 PMCID: PMC4407911 DOI: 10.1111/dme.12656] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. METHODS Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes. RESULTS Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups. CONCLUSIONS The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications.
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Affiliation(s)
- K H Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Centre, Gachon UniversityIncheon, Korea
| | - N-K Lim
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
| | - J-W Lee
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
| | - M-C Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National UniversityChungju, Korea
| | - H-Y Park
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
- Correspondence to: Hyun-Young Park. E-mail:
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Danyliv A, Gillespie P, O'Neill C, Noctor E, O'Dea A, Tierney M, McGuire B, Glynn LG, Dunne F. Short- and long-term effects of gestational diabetes mellitus on healthcare cost: a cross-sectional comparative study in the ATLANTIC DIP cohort. Diabet Med 2015; 32:467-76. [PMID: 25529506 DOI: 10.1111/dme.12678] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 11/29/2022]
Abstract
AIMS This paper examines the association between gestational diabetes mellitus and costs of care during pregnancy and 2-5 years post pregnancy. METHODS Healthcare utilization during pregnancy was measured for a sample of 658 women drawn from the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network. Healthcare utilization 2-5 years post pregnancy was assessed for a subsample of 348 women via a postal questionnaire. A vector of unit costs was applied to healthcare activity to calculate the costs of care at both time points. Differences in cost for women with gestational diabetes mellitus compared with those with normal glucose tolerance during the pregnancy were examined using univariate and multivariate regression analyses. RESULTS Gestational diabetes mellitus was independently associated with an additional €817.60 during pregnancy (€1192.1 in the gestational diabetes mellitus group, €511.6 in the normal glucose tolerance group), in the form of additional delivery and neonatal care costs, and an additional €680.50 in annual healthcare costs 2-5 years after the index pregnancy (€6252.4 in the gestational diabetes mellitus group, €5434.8 in the normal glucose tolerance group). CONCLUSIONS These results suggest that gestational diabetes mellitus is associated with increased costs of care during and post pregnancy. They provide indication of the associated cost that can be avoided or reduced by the screening, prevention and management of gestational diabetes mellitus in pregnancy. These estimates are useful for further studies that examine the cost and cost-effectiveness of such programmes.
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Affiliation(s)
- A Danyliv
- J.E. Cairnes School of Business and Economics, National University of Ireland; School of Medicine, Clinical Sciences Institute, National University of Ireland
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Saldanha IJ, Wilson LM, Bennett WL, Nicholson WK, Robinson KA. Development and pilot test of a process to identify research needs from a systematic review. J Clin Epidemiol 2013; 66:538-45. [PMID: 22995855 DOI: 10.1016/j.jclinepi.2012.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 04/19/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To ensure appropriate allocation of research funds, we need methods for identifying high-priority research needs. We developed and pilot tested a process to identify needs for primary clinical research using a systematic review in gestational diabetes mellitus. STUDY DESIGN AND SETTING We conducted eight steps: abstract research gaps from a systematic review using the Population, Intervention, Comparison, Outcomes, and Settings (PICOS) framework; solicit feedback from the review authors; translate gaps into researchable questions using the PICOS framework; solicit feedback from multidisciplinary stakeholders at our institution; establish consensus among multidisciplinary external stakeholders on the importance of the research questions using the Delphi method; prioritize outcomes; develop conceptual models to highlight research needs; and evaluate the process. RESULTS We identified 19 research questions. During the Delphi method, external stakeholders established consensus for 16 of these 19 questions (15 with "high" and 1 with "medium" clinical benefit/importance). CONCLUSION We pilot tested an eight-step process to identify clinically important research needs. Before wider application of this process, it should be tested using systematic reviews of other diseases. Further evaluation should include assessment of the usefulness of the research needs generated using this process for primary researchers and funders.
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Affiliation(s)
- Ian J Saldanha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA
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Abstract
New proposals for the diagnosis of gestational diabetes (GDM), promulgated by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), will substantially increase the number of women diagnosed with GDM. This will have an enormous impact on healthcare resources, diverting attention away from genuinely high risk diabetic pregnancies. Randomized trials in 'mild' GDM indicate that the main effects of treatment are a 2 %-3 % reduction in birth weight, fewer 'big babies', and less shoulder dystocia. However, these studies used different diagnostic criteria, and women diagnosed by the broader IADPSG criteria may not derive the same modest benefit. Modeling indicates a very high cost per QALY, unless later development of type 2 diabetes can be prevented. Far from producing consensus, the IADPSG suggestion has thrown sharply into focus the need to assess critically the risks, costs and benefits of adopting criteria that may pathologize a large number of otherwise normal pregnancies.
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Affiliation(s)
- Hélène Long
- Division of Endocrinology and Metabolism, Department of Medicine, Laval Health and Social Services Center, Laval, Québec, Canada
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31
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Abstract
The use of technology to deliver health care over a distance has drawn considerable attention and shown dramatic growth over the last decade because of the possibility it has to reduce cost and improve access to modern medical care. Diabetes in pregnancy, which requires tight glycemic control in order to reduce perinatal complications, is a prime telemedicine intervention target. A review of the literature suggests that telemedicine, although not perfect, can potentially play a role in reducing patient visits and could improve quality of life without jeopardizing the outcome.
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Affiliation(s)
- Dimitrios S Mastrogiannis
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, Temple University School of Medicine, 3401 N. Broad Street, 7th fl zone B, Philadelphia, PA 19140, USA.
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Mission JF, Ohno MS, Cheng YW, Caughey AB. Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis. Am J Obstet Gynecol 2012; 207:326.e1-9. [PMID: 22840972 PMCID: PMC4621259 DOI: 10.1016/j.ajog.2012.06.048] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/01/2012] [Accepted: 06/25/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study investigates the cost effectiveness of gestational diabetes mellitus screening using the new International Association of Diabetes in Pregnancy Study Group (IADPSG) guidelines. STUDY DESIGN 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- John F Mission
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
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Gillespie P, O'Neill C, Avalos G, Dunne FP. New estimates of the costs of universal screening for gestational diabetes mellitus in Ireland. Ir Med J 2012; 105:15-18. [PMID: 22838102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The new International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria have been predicted to increase the prevalence of gestational diabetes mellitus 2-to-3 fold and will have important resource implications for healthcare systems. A bottom-up, prevalence-based analysis was undertaken to estimate the costs of universal screening for gestational diabetes mellitus in Ireland using the new criteria. Healthcare activity was identified from the Atlantic Diabetes in Pregnancy database and grouped into five categories: (i) screening and testing, (ii) GDM treatment, (iii) prenatal care, (iv) delivery care, and (v) neonatal care. When individual resource components were valued using unit cost data and aggregated, the total healthcare cost was estimated at Euro 46,311,301 (95% CI: Euro 36,381,038, Euro 68,007,432). The average cost per case detected was Euro 351 (95% CI: (Euro 126, Euro 558) and the average total cost per case detected and treated was Euro 9,325 (95% CI: Euro 5,982, Euro 13,996). Further research is required to determine the cost effectiveness of screening in the region with a view to improving resource allocation in this area in the future.
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Affiliation(s)
- P Gillespie
- School of Business and Economics, National University of Ireland, Galway.
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Cavassini ACM, Lima SAM, Calderon IMP, Rudge MVC. Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil. SAO PAULO MED J 2012; 130:17-26. [PMID: 22344355 PMCID: PMC10906692 DOI: 10.1590/s1516-31802012000100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 02/23/2011] [Accepted: 07/20/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. STUDY DESIGN This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp). METHODS Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. RESULTS Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. CONCLUSION Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.
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Abstract
Early diagnosis of GDM is necessary to reduce maternal and fetal morbidity and mortality. As all approaches to diagnosis of GDM are costly and difficult, we meant to find an appropriate and simple way to perform this test. One-thousand six-hundred and fifty-three pregnant women were screened for GDM at 24-28 weeks of gestation. Initial screening was done by a glucose challenge test with 50 g glucose. If the 1-h blood glucose level exceeded 130 mg/dl, then a 3-h oral glucose tolerance test (OGTT) with 100 g glucose was performed, and diagnosis was established according to ADA criteria. For determining which plasma glucose level is the best test for diagnosis of GDM, we used receiver operative characteristic cures (ROC) by plotting sensitivity versus one minus specificity at different times of plasma glucose levels in OGTT. In 732 pregnant women with a positive GCT, a 2-h plasma glucose level above 150 mg/dl was the most powerful test for detecting GDM, which revealed a sensitivity and specificity of 0.84 (0.81-0.86) and 0.94 (CI: 0.92-0.96), respectively. The results of this study suggest that 2-h 100 g OGTT could be an appropriate approach to diagnose GDM, which is cost-effective and could reduce laboratory workload.
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Affiliation(s)
- Sedigheh Soheilykhah
- Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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36
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Ohno MS, Sparks TN, Cheng YW, Caughey AB. Treating mild gestational diabetes mellitus: a cost-effectiveness analysis. Am J Obstet Gynecol 2011; 205:282.e1-7. [PMID: 22071065 PMCID: PMC3443977 DOI: 10.1016/j.ajog.2011.06.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 05/03/2011] [Accepted: 06/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study investigated the cost-effectiveness of treating mild gestational diabetes mellitus (GDM). STUDY DESIGN A decision analytic model was built to compare treating vs not treating mild GDM. The primary outcome was the incremental cost per quality-adjusted life year (QALY). All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed. RESULTS Treating mild GDM was more expensive, more effective, and cost-effective at $20,412 per QALY. Treatment remained cost-effective when the incremental cost to treat GDM was less than $3555 or if treatment met at least 49% of its reported efficacy at the baseline cost to treat of $1786. CONCLUSION Treating mild GDM is cost-effective in terms of improving maternal and neonatal outcomes including decreased rates of preeclampsia, cesarean sections, macrosomia, shoulder dystocia, permanent and transient brachial plexus injury, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal intensive care unit admissions.
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Affiliation(s)
- Mika S Ohno
- Department of Obstetrics, University of California, CA, USA
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Abstract
AIMS To estimate the costs associated with universal screening for gestational diabetes mellitus in Ireland. METHODS Bottom-up, prevalence-based cost analysis. Healthcare activity identified using the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) database was grouped into five categories: screening and testing, gestational diabetes treatment, prenatal care, delivery care and neonatal care. A vector of unit cost data (euros in 2008 prices) was applied to specified resource use and the total healthcare cost calculated. A series of one-way and probabilistic sensitivity analyses were undertaken to explore the uncertainty in the analysis. RESULTS When individual resource components were valued and aggregated, the total healthcare cost of gestational diabetes in Ireland was estimated at €12 433 320 (95% CI €9 298 228-16 778 193). The average cost per case detected was €1621 (95% CI €524-2603) and the average total cost per case detected and treated was €11 903 (95% CI €7645-16 121). CONCLUSIONS This research provides the first estimates of the healthcare costs associated with gestational diabetes mellitus in Ireland. Further research is required to determine the cost-effectiveness of gestational diabetes screening in the region with a view to improving resource allocation in this area in the future.
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Affiliation(s)
- P Gillespie
- School of Business and Economics, National University of Ireland, Galway, Ireland.
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Kolu P, Raitanen J, Luoto R. Cost of gestational diabetes-related antenatal visits in health care based on the Finnish Medical Birth Register. Prim Care Diabetes 2011; 5:139-141. [PMID: 21292576 DOI: 10.1016/j.pcd.2011.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 12/21/2010] [Accepted: 01/05/2011] [Indexed: 11/30/2022]
Abstract
The aim was to evaluate frequency and costs of antenatal health care visits related to risk of gestational diabetes (GDM) using Birth Register. Costs among all GDM risk groups were 10-41% larger than non-risk groups. Primary health care is needed to reduce special health care costs related to GDM.
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Affiliation(s)
- Päivi Kolu
- UKK Institute for Health Promotion, Tampere, Finland.
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Moss JR, Crowther CA, Hiller JE, Willson KJ, Robinson JS. Costs and consequences of treatment for mild gestational diabetes mellitus - evaluation from the ACHOIS randomised trial. BMC Pregnancy Childbirth 2007; 7:27. [PMID: 17963528 PMCID: PMC2241640 DOI: 10.1186/1471-2393-7-27] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 10/28/2007] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recommended best practice is that economic evaluation of health care interventions should be integral with randomised clinical trials. We performed a cost-consequence analysis of treating women with mild gestational diabetes mellitus by dietary advice, blood glucose monitoring and insulin therapy as needed compared with routine pregnancy care, using patient-level data from a multi-centre randomised clinical trial. METHODS Women with a singleton pregnancy who had mild gestational diabetes diagnosed by an oral glucose-tolerance test between 24 and 34 weeks' gestation and their infants were included. Clinical outcomes and outpatient costs derived from all women and infants in the trial. Inpatient costs derived from women and infants attending the hospital contributing the largest number of enrolments (26.1%), and charges to women and their families derived from a subsample of participants from that hospital (in 2002 Australian dollars). Occasions of service and health outcomes were adjusted for maternal age, ethnicity and parity. Analysis of variance was used with bootstrapping to confirm results. Primary clinical outcomes were serious perinatal complications; admission to neonatal nursery; jaundice requiring phototherapy; induction of labour and caesarean delivery. Economic outcome measures were outpatient and inpatient costs, and charges to women and their families. RESULTS For every 100 women with a singleton pregnancy and positive oral glucose tolerance test who were offered treatment for mild gestational diabetes mellitus in addition to routine obstetric care, $53,985 additional direct costs were incurred at the obstetric hospital, $6,521 additional charges were incurred by women and their families, 9.7 additional women experienced induction of labour, and 8.6 more babies were admitted to a neonatal nursery. However, 2.2 fewer babies experienced serious perinatal complication and 1.0 fewer babies experienced perinatal death. The incremental cost per additional serious perinatal complication prevented was $27,503, per perinatal death prevented was $60,506 and per discounted life-year gained was $2,988. CONCLUSION It is likely that the general public in high-income countries such as Australia would find reductions in perinatal mortality and in serious perinatal complications sufficient to justify additional health service and personal monetary charges. Over the whole lifespan, the incremental cost per extra life-year gained is highly favourable. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12606000294550.
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Affiliation(s)
- John R Moss
- Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Caroline A Crowther
- Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, King William Road, North Adelaide, South Australia, 5006, Australia
| | - Janet E Hiller
- Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Kristyn J Willson
- Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Jeffrey S Robinson
- Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, King William Road, North Adelaide, South Australia, 5006, Australia
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Todorova K, Palaveev O, Petkova VB, Stefanova M, Dimitrova Z. A pharmacoeconomical model for choice of a treatment for pregnant women with gestational diabetes. Acta Diabetol 2007; 44:144-8. [PMID: 17721753 DOI: 10.1007/s00592-007-0255-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Accepted: 03/08/2007] [Indexed: 11/29/2022]
Abstract
This study discusses two main questions: the direct medical costs and the clinical effectiveness of the hospital treatment with insulin of pregnant women with gestational diabetes (GD). A prospective study that includes 50 women with GD is performed. The pregnant women are divided into 2 groups: Group I (n=30) - pregnant women treated only with a diet; and Group II (n=20) - pregnant women treated with diet and insulin. We found that the metabolite compensation degree is improved after the applied treatment with insulin. The coefficient cost/effectiveness is 6954 lv./100 women. The analysis decision tree confirms in a very convenient way the fact that insulin treatment is a clinically more effective and financially more profitable strategy.
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Affiliation(s)
- K Todorova
- Maternity Hospital Maichin Dom, Sofia, Bulgaria
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Kim C, Sinco B, Kieffer EA. Racial and ethnic variation in access to health care, provision of health care services, and ratings of health among women with histories of gestational diabetes mellitus. Diabetes Care 2007; 30:1459-65. [PMID: 17363750 DOI: 10.2337/dc06-2523] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to assess racial/ethnic variation in access to health care, use of particular health care services, presence of cardiovascular risk factors, and perceptions of health and impairment among women at risk for type 2 diabetes because of their histories of gestational diabetes mellitus (hGDM). RESEARCH DESIGN AND METHODS We performed a cross-sectional study using the 2001-2003 Behavioral Risk Factor Surveillance System, a national population-based, random sample telephone survey. We assessed access to health care, use of family planning, measurement and elevation of cholesterol, elevation of blood pressure, and respondents' perceptions of health and impairment among women aged 18-44 years with hGDM (n = 4,718). Multivariate models adjusted for sociodemographic characteristics, BMI, presence of children in the household, and current smoking. RESULTS Outcome measures were suboptimal across racial/ethnic groups. Approximately one-fifth of the overall population reported no health insurance, cost barriers to physician visits, and no primary care provider. One-quarter had no examination within the past year, and almost one-fifth reported no family planning and elevated cholesterol levels. Latinas were the most disadvantaged, with 40% reporting no health insurance and no primary care provider and one-fourth reporting suboptimal perceptions of health. Asian/Pacific Islanders were the most advantaged in terms of health care access, cholesterol and blood pressure elevation, and impaired physical health. Racial/ethnic differences in health care use and presence of risk factors were not entirely explained by health care access or other covariates. CONCLUSIONS Significant racial/ethnic variation exists among women with hGDM for access to and use of health care, presence of risk factors, and perceptions of health.
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Affiliation(s)
- Catherine Kim
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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Tanaka M, Jaamaa G, Kaiser M, Hills E, Soim A, Zhu M, Shcherbatykh IY, Samelson R, Bell E, Zdeb M, McNutt LA. Racial disparity in hypertensive disorders of pregnancy in New York State: a 10-year longitudinal population-based study. Am J Public Health 2006; 97:163-70. [PMID: 17138931 PMCID: PMC1716255 DOI: 10.2105/ajph.2005.068577] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We studied trends of hypertensive disorders of pregnancy by residential socioeconomic status (SES) and racial/ethnic subgroups in New York State over a 10-year period. METHODS We merged New York State discharge data for 2.5 million women hospitalized with delivery from 1993 through 2002 with 2000 US Census data. RESULTS Rates of diagnoses for all hypertensive disorders combined and for preeclampsia individually were highest among Black women across all regions and neighborhood poverty levels. Although hospitalization rates for preeclampsia decreased over time for most groups, differences in rates between White and Black women increased over the 10-year period. The proportion of women living in poor areas remained relatively constant over the same period. Black and Hispanic women were more likely than White women to have a form of diabetes and were at higher risk of preeclampsia; preeclampsia rates were higher in these groups both with and without diabetes than in corresponding groups of White women. CONCLUSIONS An increasing trend of racial/ethnic disparity in maternal hypertension rates occurred in New York State during the past decade. This trend was persistent after stratification according to SES and other risk factors. Additional research is needed to understand the factors contributing to this growing disparity.
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Affiliation(s)
- Masako Tanaka
- School of Public Health, University at Albany, State University of New York 12144, USA
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Ayach W, Costa RAA, Calderon IDMP, Rudge MVC. Comparison between 100-g glucose tolerance test and two other screening tests for gestational diabetes: combined fasting glucose with risk factors and 50-g glucose tolerance test. SAO PAULO MED J 2006; 124:4-9. [PMID: 16612455 DOI: 10.1590/s1516-31802006000100002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Lack of consensus about which screening tests to use for gestational diabetes mellitus (GDM) and difficulties in performing the gold-standard diagnostic test, the 100-g glucose tolerance test (100-g GTT), justify comparison with alternatives. The aim was to compare this with two other screening tests: combined fasting glucose with risk factors (FG + RF) and 50-g GTT. DESIGN AND SETTING Prospective longitudinal cohort study in the Hospital School of Universidade Federal de Mato Grosso do Sul. METHODS The three tests were performed independently on 341 pregnant women. Sensitivity (S), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (PLR) and negative (NLR) likelihood ratios, and false-positive (FP) and false-negative (FR) rates obtained with FG + RF and 50-g GTT were compared with values from 100-g GTT. The average one-hour post-intake glucose levels (1hPG) with 50-g and 100-g were compared. Students t test was used in the statistical analysis. RESULTS FG + RF led more pregnant women (53.9%) to diagnostic confirmation than did 50-g GTT (14.4%). The tests were equivalent for S (86.4 and 76.9%), PPV (98.7 and 98.9%), NLR (0.3 and 0.27) and FR (15.4 and 23.1%). Average 1hPG values were similar: 50-g GTT = 106.8 mg/dl and 100-g GTT = 107.5 mg/dl. CONCLUSION Diagnostic efficiency with simplicity, practicality and low cost make FG + RF more appropriate for screening for GDM. The equivalence of 1hPG allows a new, cheaper and less uncomfortable protocol to be proposed for screening and diagnosing GDM.
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Affiliation(s)
- Wilson Ayach
- Department of Gynecology and Obstetrics, Hospital Universitário, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
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Alberico S, Strazzanti C, De Santo D, De Seta F, Lenardon P, Bernardon M, Zicari S, Guaschino S. Gestational diabetes: universal or selective screening? J Matern Fetal Neonatal Med 2005; 16:331-7. [PMID: 15621551 DOI: 10.1080/14767050400018114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To evaluate the incidence of gestational diabetes in our population and verify costs of universal screening. To assess neonatal and obstetrical outcomes with respect to maternal epidemiological characteristics. METHODS Eight hundred and fifty-six pregnant women between 24th and 28th weeks of gestation were examined in this observational study. Universal screening with glucose challenge test was used to screen the group for gestational diabetes. History, obstetrical and neonatal outcomes were collected and then analyzed. RESULTS Gestational diabetes was diagnosed in 6.6% of cases. Patients with at least one risk factor had a cesarean section in 50% of cases and a spontaneous vaginal delivery in 23.59% of cases (p < 0.001). The absence of any risk factor was found in 73.7% of positive glucose tolerance test and in 62.5% of affected patients. The cost of universal screening in our study, was 57,60 Euros per case identified. CONCLUSIONS Given the high prevalence of diabetes, the high proportion of patients potentially not identified with a selective screening in this study and the relatively low cost, universal screening for gestational diabetes seems the best way to identify patients and prevent adverse obstetrical and neonatal outcomes.
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Affiliation(s)
- Salvatore Alberico
- Department of Obstetrics and Gynecology, IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy
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Rey E, Hudon L, Michon N, Boucher P, Ethier J, Saint-Louis P. Fasting plasma glucose versus glucose challenge test: screening for gestational diabetes and cost effectiveness. Clin Biochem 2005; 37:780-4. [PMID: 15329316 DOI: 10.1016/j.clinbiochem.2004.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Revised: 05/18/2004] [Accepted: 05/18/2004] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare the performance in screening for gestational carbohydrate intolerance of the 1-h 50-g glucose challenge test (GCT), fasting plasma glucose (FPG) and fasting capillary glucose (FCG). DESIGN AND METHODS FPG and FCG were measured at the same time as the GCT in 188 women. Gestational carbohydrate intolerance was diagnosed according to the Canadian Diabetes Association criteria. We constructed receiver operator characteristic (ROC) curves and compared the sensitivity and specificity of the FPG, FCG and GCT. RESULTS Gestational diabetes was diagnosed in 11.2% women and gestational impaired glucose tolerance in 8.4%. The areas under the ROC curves for the FPG, the GCT and the FCG were not statistically different (P = 0.26). The GCT yielded a better specificity than the FPG and the FCG for a comparable level of sensitivity. CONCLUSIONS The GCT is better than the FPG in our population and is cost effective.
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Affiliation(s)
- Evelyne Rey
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, QC, H3T 1C5, Canada.
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Abstract
OBJECTIVE To compare the costs associated with glyburide compared to insulin for the treatment of gestational diabetes unresponsive to dietary therapy. STUDY DESIGN A cost model was designed. The model excluded costs that were identical for both treatment arms, such as the cost of monitoring glucose control. Insulin treatment costs included average wholesale drug costs, wholesale delivery costs (syringes, alcohol pads), and costs of office staff educating patients. Glyburide costs were based on average wholesale drug costs. Downstream costs of potential inpatient evaluation for hypoglycemia were included in the model. RESULTS In our baseline model, glyburide was significantly less costly than insulin for the treatment of gestational diabetes. The average cost saving per patient based on wholesale drug costs and hospital costs was US$165.84. Actual retail drug savings and hospital charge savings are potentially considerably greater. The strongest determinant of cost savings was medication cost. The model was less sensitive to the one-time costs of inpatient treatment and patient education. CONCLUSION Glyburide is less costly than insulin for the treatment of gestational diabetes. Cost models can be useful to physicians deciding between two equally efficacious medications, allowing them to incorporate information about their individual practice styles with a complex balance of cost implications.
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Affiliation(s)
- Laura Goetzl
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
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Nachum Z, Ben-Shlomo I, Weiner E, Ben-Ami M, Shalev E. Diabetes in pregnancy: efficacy and cost of hospitalization as compared with ambulatory management--a prospective controlled study. Isr Med Assoc J 2001; 3:915-9. [PMID: 11794914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pregnant diabetic women are often subjected to frequent and prolonged hospitalizations to assure tight glycemic control, but in recent years attempts have been made at ambulatory control. The financial and social advantages of ambulatory management are obvious, but no report to date has prospectively compared its efficacy with that of hospitalization. OBJECTIVES To evaluate the efficacy and cost of ambulatory care as compared to repeated hospitalizations for management of diabetes in pregnancy. METHODS We conducted an 8 year prospective controlled study that included 681 diabetic women, experiencing 801 singleton pregnancies, with commencement of therapy prior to 34 gestational weeks. During 1986-1989, 394 pregnancies (60 pregestational diabetes mellitus and 334 gestational diabetes mellitus) were managed by hospitalization, and for the period 1990-1993, 407 pregnancies (61 PGDM and 346 GDM) were managed ambulatorily. Glycemic control, maternal complications, perinatal mortality, neonatal morbidity and hospital cost were analyzed. RESULTS There was no difference in metabolic control and pregnancy outcome in women with PGDM between the hospitalized and the ambulatory groups. Patients with GDM who were managed ambulatorily had significantly lower mean capillary glucose levels, later delivery and higher gestational age at induction of labor as compared to their hospitalized counterparts. In this group there were also lower rates of neonatal hyperbilirubinemia, phototherapy and intensive care unit admissions and stay. The saved hospital cost (in Israeli prices) in the ambulatory group was $6,000 and $15,000 per GDM and PGDM pregnancy, respectively. CONCLUSIONS Ambulatory care is as effective as hospitalization among PGDM patients and more effective among GDM patients with regard to glycemic control and neonatal morbidity. This is not only more convenient for the pregnant diabetic patient, but significantly reduces treatment costs.
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Affiliation(s)
- Z Nachum
- Department of Obstetrics and Gynecology, HaEmek Medical Center, Afula, Israel
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Abstract
OBJECTIVES To assess the prevalence and association of frequently used screening risk factors for gestational diabetes mellitus (GDM) and to compare the validity and cost of universal screening with risk factor screening. METHOD A cross-sectional survey of 768 pregnant women at > or = 24 weeks' gestation who were attending the antenatal clinic at the Hospital Universiti Kebangsaan Malaysia (HUKM) was made. Risk factors were determined using a questionnaire. An abnormal oral glucose tolerance test was defined as a 2-h post-prandial blood sugar level of > or = 7.8 mmol/l. RESULTS A total of 191 pregnant mothers (24.9%) had GDM. The most commonly identified screening factors were positive family history of diabetes mellitus (31.4%), history of spontaneous abortion (17.8%), vaginal discharge and pruritus vulvae in current pregnancy (16.0%), and maternal age greater than 35 years (14.7%). Five hundred and thirteen mothers (66.8%) had at least one risk factor. All screening risk factors, except past history of diabetes mellitus in previous pregnancy and maternal age, were not significantly associated with abnormal glucose tolerance (GT). Risk factor screening gave a sensitivity of 72.2% and a specificity of 35.0%. Universal screening would cost RM 12.06 while traditional risk factor screening would cost RM 11.15 per identified case and will have missed 53 of the 191 cases. CONCLUSIONS Risk factor screening scored poorly in predicting GDM. Cost analysis of universal compared with traditional risk factor screening showed a negligible difference. Thus universal screening appears to be the most reliable method of diagnosing GDM.
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Affiliation(s)
- K Shamsuddin
- Department of Community Health, Medical Faculty, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
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Lavin JP, Lavin B, O'Donnell N. A comparison of costs associated with screening for gestational diabetes with two-tiered and one-tiered testing protocols. Am J Obstet Gynecol 2001; 184:363-7. [PMID: 11228488 DOI: 10.1067/mob.2001.109401] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Fourth International Workshop on Gestational Diabetes recently suggested that two techniques, a 2-tiered protocol and a 1-tiered protocol, to screen for gestational diabetes mellitus are acceptable alternatives. This study was undertaken to compare the direct costs and patient time expenditures associated with implementing both techniques. STUDY DESIGN A MEDLINE search was undertaken to determine the prevalence of positive and negative screening results. Direct costs of testing were estimated by determining the range of supply costs from manufacturers' catalogs and the labor costs by estimating the time required to perform each procedure and multiplying by the appropriate range of wages; these costs were then multiplied by the appropriate range of the number of procedures required to implement both protocols, and the totals were summed. Patient time expended was estimated by assigning test times of 1, 2, and 3 hours for the 50-g screening glucose challenge test, the 75-g oral glucose tolerance test, and the 100-g oral glucose tolerance test, respectively. If additional visits were required, 2 travel-time units were assigned each time a patient underwent a procedure. These units were multiplied by the range of patients undergoing various tests to implement the alternative protocols. RESULTS We identified low and high direct costs, test times, and travel units per patient screened by the 1- and 2-tiered testing protocols. Low and high direct costs were $3.46 and $7.88, respectively, for the 2-tiered protocol and $5.64 and $10.88, respectively, for the 1-tiered protocol (relative ratios, 1.63 for low direct costs in each protocol and 1.38 for high direct costs in each protocol). Low and high test times were 1.4 and 1.5 hours, respectively, for the 2-tiered protocol and 2.0 and 2.0 hours, respectively, for the 1-tiered protocol (relative ratios, 1.47 for low test times in each protocol and 1.32 for high test times in each protocol). Low and high travel units for the 2-tiered protocol were 0.2 and 0.3, respectively, when the glucose challenge test was given at the prenatal visit, and 2.2 and 2.3, respectively, when the test was not given at that time. Low and high travel units for the 1-tiered protocol were 8.3 and 5.8, respectively, when the glucose challenge test was given at the prenatal visit, and 0.89 and 0.85, respectively, when the test was not given at that time. CONCLUSIONS The 2-tiered protocol appears to be associated with lower direct implementation costs and less patient time expenditure than the 1-tiered scheme. The 1-tiered protocol is associated with slightly less travel time, but this is unlikely to offset the test time advantage of the 2-tiered protocol. Until further data regarding the relative clinical utility of the 2 protocols become available, these factors may be important for clinicians in deciding which screening format to follow.
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Affiliation(s)
- J P Lavin
- Division of Maternal-Fetal Medicine, Summa Health System and Akron General Medical Center, and Northeastern Ohio Universities College of Medicine, 44304, USA
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