| Title: |
Exploring Structural Uncertainty in Cost-Effectiveness Modeling of Gestational Diabetes Screening: An Application Example from Norway |
| Authors: |
Henkel, Pia S.; Burger, Emily A.; Sletner, Line; Pedersen, Kine |
| Contributors: |
universitetet i oslo |
| Source: |
Medical Decision Making ; volume 44, issue 4, page 380-392 ; ISSN 0272-989X 1552-681X |
| Publisher Information: |
SAGE Publications |
| Publication Year: |
2024 |
| Description: |
Background Screening pregnant women for gestational diabetes mellitus (GDM) has recently been expanded in Norway, although screening eligibility criteria continue to be debated. We aimed to compare the cost-effectiveness of alternative GDM screening strategies and explored structural uncertainty and the value of future research in determining the most cost-effective eligibility criteria for GDM screening in Norway. Design We developed a probabilistic decision tree to estimate the total costs and health benefits (i.e., quality-adjusted life-years; QALYs) associated with 4 GDM screening strategies (universal, current guidelines, high-risk, and no screening). We identified the most cost-effective strategy as the strategy with the highest incremental cost-effectiveness ratio below a Norwegian benchmark for cost-effectiveness ($28,400/QALY). We excluded inconclusive evidence on the effects of screening on later maternal type 2 diabetes mellitus (T2DM) in the primary analysis but included this outcome in a secondary analysis using 2 different sources of evidence (i.e., Cochrane or US Preventive Services Task Force). To quantify decision uncertainty, we conducted scenario analysis and value-of-information analyses. Results Current screening recommendations were considered inefficient in all analyses, while universal screening was most cost-effective in our primary analysis ($26,014/QALY gained) and remained most cost-effective when we assumed a preventive effect of GDM treatment on T2DM. When we assumed no preventive effect, high-risk screening was preferred ($19,115/QALY gained). When we assumed GDM screening does not prevent perinatal death in scenario analysis, all strategies except no screening exceeded the cost-effectiveness benchmark. In most analyses, decision uncertainty was high. Conclusions The most cost-effective screening strategy, ranging from no screening to universal screening, depended on the source and inclusion of GDM treatment effects on perinatal death and T2DM. Further research on these long-term ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1177/0272989x241241339 |
| DOI: |
10.1177/0272989X241241339 |
| Availability: |
https://doi.org/10.1177/0272989x241241339; https://journals.sagepub.com/doi/pdf/10.1177/0272989X241241339; https://journals.sagepub.com/doi/full-xml/10.1177/0272989X241241339 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.A78C8C32 |
| Database: |
BASE |