Postpartum Screening for Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus: A Cost-Effectiveness Analysis in Singapore

Andrea Cremaschi; Willem van den Boom; Nicholas Beng Hui Ng; Beatrice Franzolini; Kelvin B Tan; Jerry Kok Yen Chan; Kok Hian Tan; Yap-Seng Chong; Johan G Eriksson; Maria De Iorio

doi:10.1016/j.vhri.2024.101048

Postpartum Screening for Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus: A Cost-Effectiveness Analysis in Singapore

Value Health Reg Issues. 2024 Oct 29:45:101048. doi: 10.1016/j.vhri.2024.101048. Online ahead of print.

Authors

Affiliations

¹ School of Science and Technology, IE University, Madrid, Spain.
² Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore. Electronic address: Willem_van_den_Boom@sics.a-star.edu.sg.
³ Department of Paediatrics, National University Hospital, Singapore, Singapore.
⁴ Bocconi Institute for Data Science and Analytics, Bocconi University, Milan, Italy.
⁵ Ministry of Health, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
⁶ Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore.
⁷ Duke-NUS Medical School, Singapore, Singapore; Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
⁸ Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore; Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore.
⁹ Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore; Department of Paediatrics, National University of Singapore, Singapore, Singapore.

PMID: 39476753
DOI: 10.1016/j.vhri.2024.101048

Abstract

Objectives: In Singapore, diabetes imposes a huge population health and economic burden. Despite that, there is paucity of evidence on the health economics of screening programs for type 2 diabetes, especially in the context of screening after gestational diabetes (GDM). The objective of this study is to assess cost-effectiveness of universal lifelong screening for type 2 diabetes after GDM, which is supported by current guidelines, compared with elective screening where 54% of mothers with GDM undertake one-off screening. Despite the recommendation for universal lifelong screening, only 54% comply with this in the first postpartum year.

Methods: We perform a cost-effectiveness analysis comparing 5 screening strategies, accounting for lifetime costs to the healthcare system and quality of life for Singapore women diagnosed with GDM. In particular, a hybrid decision model, based on a decision tree and Markov models, is implemented to estimate cost and quality-adjusted life-years (QALY). Probabilities, costs, and utilities are obtained from existing literature, governmental databases, the Growing Up in Singapore Towards Healthy Outcomes birth cohort study, and the National University Hospital.

Results: Compared with elective screening, universal annual screening reduces cost by SG$19.4 million while adding 3.8 thousand QALYs by each annual cohort of pregnant women. Furthermore, annual screening is cost-effective (lower cost and higher QALY) compared with triennial screening. Sensitivity analysis shows that the findings are robust to parameter specifications.

Conclusions: Universal annual screening of women with a history of GDM is cost-effective for reducing diabetes complications compared with strategies with less frequent screening in Singapore.

Keywords: Growing Up in Singapore Towards Healthy Outcomes (GUSTO) birth cohort study; Markov model; hybrid decision model; lifelong annual screening; quality-adjusted life-years.