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Is Screening and Integrated Care for GDM Cost Effective?

This study examines the cost-effectiveness of screening and integrated care for gestational diabetes mellitus (GDM), identifying high future risk of diabetes and cardiovascular diseases. It also addresses the high risk of maternal and perinatal complications and poor pregnancy outcomes associated with GDM. The study analyzes the potential savings and costs of treating GDM and its long-term implications, including the prevention of type 2 diabetes in offspring. Conclusions are drawn based on various perspectives, including health system, extended dominance, immediate non-communicable disease (NCD), maternal and child health (MCH), and societal perspectives.

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Is Screening and Integrated Care for GDM Cost Effective?

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  1. Is Screening and Integrated Care for GDM Cost Effective? Anil Kapur

  2. Identifies women at high future risk of diabetes, CVD offers opportunity of primary prevention High risk of maternal and perinatal morbidity and mortality and poor pregnancy outcome Offspring of GDM pregnancy at high risk of metabolic problems including type 2 diabetes

  3. Atlantic DIP Study Diabetologia 2011

  4. In 23 developing countries maternal diabetes and obesity increased the risk of macrosomia 2 to 3 fold Increased risk of birth trauma, asphyxia, and meconium aspiration Emergency caesarean section due to obstructed labour High risk of abnormal haemorrhage, uterine atony, and prolonged labour. These complications probably contributed to the excessive adverse maternal and perinatal outcomes shown in the study The Lancet 2013; 381: 476-483

  5. Leanne Bellamy, Juan-Pablo Casas, Aroon D Hingorani, David Williams Lancet 2009; 373: 1773–79

  6. . Evidence that treating GDM prevents Type 2 diabetes in Offspring is lacking

  7. ~127 Million Pregnancies/Year ~21 million /year complicated by hyperglycaemia ~3 to 4 million detected and treated ? Receive Post partum follow up and lifestyle advice

  8. ?

  9. According to the WHO CHOISE analysis any intervention in a given country is considered • highly cost-effective if its cost is less than its annual GDP per capita; • cost-effective when it is between one and three times GDP per capita; • not cost-effective when it is more than three times GDP per capita.

  10. Extended Dominance Dominant

  11. Health System Perspective Long Term (Discounted) Screen & Diagnose • Savings depend on • Efficacy of Rx • Type & severity of complications averted Treat Postpartum Lifestyle T2D in mother CVD in mother • Savings depend on • Cost of Rx DM, CVD and their complications in future GDM Perinatal complications T2D/NCDs in offspring • Costs depend on • Technology • Criteria used • Cut off values • Prevalence Costs depend on type & efficacy of interventions Immediate NCD Perspective MCH Perspective

  12. GDM Cost Effectiveness Model S Societal Perspective

  13. Studies on Cost Effectiveness of GDM Screening and Treatment

  14. Conclusions

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