Cost analysis of different screening strategies for gestational diabetes mellitus.

OBJECTIVE To analyze the findings of a survey in Tehran, Iran, to determine the screening method for gestational diabetes mellitus (GDM) best suited to the local population. METHODS In four university teaching hospitals in Tehran, 2,416 pregnant women were classified into high-, intermediate-, and low-risk groups, on the basis of criteria established by the American Diabetes Association, and then screened for GDM. A two-step approach was implemented, with use of blood glucose thresholds of 130 mg/dL and 140 mg/dL and the previously advocated diagnostic criteria of two or more abnormal results of an oral glucose tolerance test. RESULTS The prevalence of GDM is increasing globally, and the major determinants of screening programs for GDM are the cost-to-benefit ratio and the prevalence in the target population. The prevalence of GDM in our study sample was 4.7%. Changing from the 130 mg/dL to the 140 mg/dL blood glucose threshold decreased case-detection sensitivity by 12%, to 88%. With this approach, however, the cost of screening for GDM per pregnancy decreased from US dollars 3.80 to US dollars 3.21 (-15.5%), and the cost per detected case of GDM declined from US dollars 80.56 to US dollars 77.44 (-3.9%). CONCLUSION We recommend universal screening for GDM in populations, such as ours, that have a substantial baseline prevalence of GDM and variable health-care coverage. In such a setting, a considerable proportion of cases of GDM may be missed. Moreover, universal screening is less expensive in developing countries than in more developed economies and leads to clearer long-term savings for a health service stretched to the limit.