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The HAPO study demonstrated a linear relationship between maternal hyperglycemia and adverse pregnancy outcomes. Subjects were divided into seven categories according to fasting glucose levels, with Category 4 representing patients with glycemic levels in the top 12-23%, representing patients just below the cutoff for gestational diabetes (GDM) under the new IADPSG guidelines. This study examines the cost-effectiveness of treating patients in HAPO Category 4 for GDM, accounting for the costs and benefits of treating hyperglycemia in pregnancy.
A decision analytic model was built using TreeAge software that compared treatment vs. no treatment for patients in HAPO Category 4. Outcomes included preeclampsia, mode of delivery, maternal death, macrosomia, shoulder dystocia, brachial plexus injury (permanent and transient), hypoglycemia, hyperbilirubinemia, and neonatal death. Existing randomized controlled trials were used to estimate the effect of treatment on outcomes. Utilities were applied to discounted life expectancy at a discount rate of 3% to generate QALYs. In addition, an index adjusting for treatment efficacy was used for sensitivity analysis. The cost-effectiveness threshold was set to $100,000 per QALY.
Treating patients in HAPO Glucose Category 4 was more effective (56.914280 QALYs with treatment vs 56.903297 without treatment) but more expensive ($12,660.70 with treatment vs $11,514.91 without treatment), with an incremental cost of $104,323.96/QALY. In a one-way sensitivity analysis of the effect of treatment on outcomes, treatment must exceed 102.6% of its expected effect for treating HAPO Group 4 to become cost-effective.
Treating patients in Category 4 of the HAPO Study for GDM is not cost-effective. Further studies to investigate other methods of improving perinatal outcomes in this group are warranted.