Effect of varying threshold and selective versus universal strategies on the cost in gestational diabetes mellitus

Background – The prevalence of gestational diabetes mellitus (GDM) is increasing globally, and the major determinants of screening programs are cost-benefit and prevalence in the target population. We aimed at assessing the screening method best-suited for a selected population in Tehran.Methods – A total number of 2,416 pregnant women were classified into high-, intermediate-, and low-risk groups, according to the American Diabetic Association (ADA) criteria. They were then screened for GDM at Tehran’s teaching hospitals using the two-step approach with thresholds of 130 mg/dL and 140 mg/dL, and the diagnostic criteria advocated by Carpenter and Coustan.Results – The prevalence of GDM in our sample was 4.7%. Switching from the 130 mg/dL to the 140 mg/dL threshold, decreased case-detection sensitivity by 12% (to 88%). With this approach, however, the cost of screening per pregnancy dropped from US $3.80 to US $3.20 (-15.6%), and the cost per detected case of GDM, from US $80.56 to US $77.43 (–3.9%).Conclusion – We recommend a universal screening for populations in whom there is a significant prevalence of GDM and variable health-care coverage, leading to a significant proportion of cases being missed, but where the cost of universal screening is markedly lower than that in more developed economies.