Postdelivery Intervention to Prevent Type 2 Diabetes and the Cost-Effectiveness of Screening Criteria for Gestational Diabetes
IMPLEMENTATION EVALUATION — Volume 19 — December 29, 2022
PEER REVIEWED
Figure.
Sensitivity analysis on incremental cost-effectiveness ratios (ICERs) for International Association of Diabetes in Pregnancy Study Group (IADPSG) (2) screening criteria compared with Carpenter–Coustan (1) screening criteria for gestational diabetes. The ICER is calculated as the difference in costs divided by the difference in quality-adjusted life years (QALYs). We considered ICERs cost-effective if they were <$150,000 per QALY. The lower the ICER, the more cost-effective IADPSG criteria compared with Carpenter–Coustan criteria. The figure is centered on the model’s expected ICER value of $127,975, slightly higher than the averaged results across the 10,000 simulations. Values in parentheses are parameter ranges. Abbreviations: DPP, Diabetes Prevention Program; NICU, neonatal intensive care.
| Parameter | Parameter range | Incremental cost-effectiveness ratio, $ | |
|---|---|---|---|
| Low | High | ||
| 10-year risk reduction in type 2 diabetes for people participating in DPP–based postdelivery intervention | 40% to 5% | 57,778 | 465,635 |
| Participation rate in DPP–based postdelivery intervention among people with IADPSG-defined or Carpenter–Coustan-defined screening criteria | 60% to 5% | 13,442 | 246,222 |
| 10-Year risk of type 2 diabetes for people with history of IADPSG-defined gestational diabetes | 16% to 6% | 84,384 | 236,281 |
| Utility decrement for type 2 diabetes | 0.15 to 0.05 | 97,115 | 218,988 |
| Relative risk of preeclampsia or gestational hypertension among people who receive treatment for gestational diabetes | 50% to 0% | 101,510 | 193,614 |
| Relative risk of admission to NICU among people who receive treatment for gestational diabetes | 40% to 0% | 102,613 | 164,779 |
| Relative risk of cesarean delivery among people who receive treatment for gestational diabetes | 20% to 0% | 104,135 | 152,362 |
| Multiplier for calculating the prevalence of IADPSG-defined gestational diabetes based on the prevalence of Carpenter–Coustan-defined gestational diabetes | 2.0 to 5.0 | 118,030 | 148,339 |
| 10-Year postdelivery costs of having type 2 diabetes | $80,000 to $20,000 | 120,977 | 141,262 |
| Prevalence of Carpenter–Coustan-defined gestational diabetes | 6% to 10% | 122,868 | 134,940 |
| Cost of DPP-based postdelivery intervention | $400 to $800 | 124,496 | 130,492 |
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