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Postdelivery Intervention to Prevent Type 2 Diabetes and the Cost-Effectiveness of Screening Criteria for Gestational Diabetes

IMPLEMENTATION EVALUATION — Volume 19 — December 29, 2022

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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.

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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