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A cost-effectiveness comparison of the NICE 2015 and WHO 2013 diagnostic criteria for women with gestational diabetes with and without risk factors.

A cost-effectiveness comparison of the NICE 2015 and WHO 2013 diagnostic criteria for women with gestational diabetes with and without risk factors.
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Jacklin PB, Maresh MJ, Patterson CC, Stanley KP, Dornhorst A, Burman-Roy S, Bilous RW,


Jacklin PB, Maresh MJ, Patterson CC, Stanley KP, Dornhorst A, Burman-Roy S, Bilous RW, (click to view)

Jacklin PB, Maresh MJ, Patterson CC, Stanley KP, Dornhorst A, Burman-Roy S, Bilous RW,

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BMJ open 2017 08 117(8) e016621 doi 10.1136/bmjopen-2017-016621
Abstract
OBJECTIVES
To compare the cost-effectiveness (CE) of the National Institute for Health and Care Excellence (NICE) 2015 and the WHO 2013 diagnostic thresholds for gestational diabetes mellitus (GDM).

SETTING
The analysis was from the perspective of the National Health Service in England and Wales.

PARTICIPANTS
6221 patients from four of the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study centres (two UK, two Australian), 6308 patients from the Atlantic Diabetes in Pregnancy study and 12 755 patients from UK clinical practice.

PRIMARY AND SECONDARY OUTCOME MEASURES PLANNED
The incremental cost per quality-adjusted life year (QALY), net monetary benefit (NMB) and the probability of being cost-effective at CE thresholds of £20 000 and £30 000 per QALY.

RESULTS
In a population of pregnant women from the four HAPO study centres and using NICE-defined risk factors for GDM, diagnosing GDM using NICE 2015 criteria had an NMB of £239 902 (relative to no treatment) at a CE threshold of £30 000 per QALY compared with WHO 2013 criteria, which had an NMB of £186 675. NICE 2015 criteria had a 51.5% probability of being cost-effective compared with the WHO 2013 diagnostic criteria, which had a 27.6% probability of being cost-effective (no treatment had a 21.0% probability of being cost-effective). For women without NICE risk factors in this population, the NMBs for NICE 2015 and WHO 2013 criteria were both negative relative to no treatment and no treatment had a 78.1% probability of being cost-effective.

CONCLUSION
The NICE 2015 diagnostic criteria for GDM can be considered cost-effective relative to the WHO 2013 alternative at a CE threshold of £30 000 per QALY. Universal screening for GDM was not found to be cost-effective relative to screening based on NICE risk factors.

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