Background
Methods
Data sources
Cost analysis
Sensitivity analyses
Results
Mother’s characteristics
GDM (N = 11,540) | Euglycemia (N = 434,272) | Source | |||
---|---|---|---|---|---|
Age (mean ± SD) | 33.7 ± 5.4 | 31.6 ± 5.6 | [13] | ||
Advanced age (≥35) | 5369 | 46.5% | 140,238 | 32.3% | [13] |
Overweight/Obesity | 276 | 2.4% | 1190 | 0.3% | [13] |
Foreign citizenship | 3920 | 34.0% | 82,433 | 19.0% | [13] |
University degreea | 1370 | 13.3% | 61,349 | 15.1% | [13] |
Antenatal outpatient costs
Category | Resource | Consumption | Code | Unit cost (€) | Total costs per case (€) | Source | ||||
---|---|---|---|---|---|---|---|---|---|---|
GDM (Diet)
|
GDM (Insulin)
|
Euglycemia
|
GDM (Diet)
|
GDM (Insulin)
|
Euglycemia
| |||||
Screening | OGTT 75 g | 2 | 2 | 1 | 90.26.4 | 2.38 | 4.76 | 4.76 | 2.38 | [6] |
Self-monitoring blood glucose kit | Glucometer | Yes | Yes | No | – | Free of charge | 0.0 | 0.0 | 0.0 | Expert opinion |
Test strip | 2/day | 4/day | No | – | 0.55 | 99.0 | 198.0 | 0.0 | ||
Finger stick | 2/day | 4/day | No | – | 0.10 | 18.0 | 36.0 | 0.0 | [24] | |
Insulin therapy | Insulin (shot) | No | 1–2 shots/day | No | – | 6.34 | 0.0 | 570.6 | 0.0 | |
Needle | No | No | – | 0.14 | 0.0 | 12.6 | 0.0 | [24] | ||
Syringe | No | No | – | 0.11 | 0.0 | 9.9 | 0.0 | [24] | ||
Visits and exams | Obstetric visit | Every 3–4 weeks | Every 1–2 weeks | Every 5–6 weeks | 89.26 | 20.66 | 62.0 | 124.0 | 41.3 | Expert opinion; [26] |
Obstetric ultrasound | 2 (at 32th week and 36th week) | No | 88.78.2 | 30.99 | 62.0 | 62.0 | 0.0 | Expert opinion; [17] | ||
Visual field test | 1 | No | 95.05 | 16.78 | 16.8 | 16.8 | 0.0 | [17] | ||
Total costs | 262.5 | 1034.6 | 43.7 |
Inpatient costs
DRG | Description | Euglycemia (N = 430,851) | GDM (N = 11,434) | Source | ||
---|---|---|---|---|---|---|
370 | Caesarean section with CC | 11,437 | 2.6% | 538 | 4.7% | [13] |
371 | Caesarean section without CC | 145,212 | 33.7% | 4019 | 35.2% | [13] |
372 | Vaginal delivery with CC | 9447 | 2.2% | 447 | 3.9% | [13] |
373 | Vaginal delivery without CC | 260,036 | 60.3% | 6287 | 55.0% | [13] |
374 | Vaginal delivery with sterilization and/or dilatation and curettage | 4274 | 1.0% | 125 | 1.1% | [13] |
375 | Vaginal delivery with other interventions but sterilization and/or dilatation and curettage | 445 | 0.1% | 18 | 0.2% | [13] |
Macrosomia | Hypoglycemia | Hyperbilirubinemia | Shoulder dystocia | Respiratory distress | Brachial plexus injury | Normal newborn | |
---|---|---|---|---|---|---|---|
Euglycemia | Yes (7.4%) | 2.4% | 7.6% | 6.0% | 1.7% | 0.7% | 81.6% |
No | 1.2% | 9.1% | 0.9% | 1.2% | 0.1% | 87.5% | |
GDM | Yes (8.7%) | 5.3% | 13.2% | 10.5% | 4.0% | 2.6% | 64.4% |
No | 2.6% | 10.4% | 1.6% | 1.5% | 0.2% | 83.7% | |
Source | [18] | [14] | [14] | [14] | [14] | [14] | Own calculation |
Code(s) | Event | Cost (€) | Source | ||
---|---|---|---|---|---|
Euglycemia | GDM | ||||
Mother | 370a | Caesarean section with CC | 2774.5 | 2938.5 | [13] |
371a | Caesarean section without CC | 2084.3 | 2373.0 | [13] | |
372a | Vaginal delivery with CC | 1610.3 | 1802.8 | [13] | |
373a | Vaginal delivery without CC | 1269.3 | 1385.2 | [13] | |
374a | Vaginal delivery with sterilization and/or dilatation and curettage | 2116.0 | 2330.9 | [13] | |
375a | Vaginal delivery with other interventions but sterilization and/or dilatation and curettage | 2842.0 | 3265.9 | [13] | |
Infant | 769b | Respiratory distress | 24,337.8 | [13] | |
775.0/775.6b | Hypoglycemia | 6571.8 | [13] | ||
774.2/774.6b | Hyperbilirubinemia | 2854.2 | [13] | ||
767.6b | Brachial plexus injury | 1671.9 | [13] | ||
660.4b | Shoulder dystocia | 1407.6 | [13] | ||
391a | Normal newborn | 560.0 | [13] |
Overall costs
Outpatient | Inpatient | Inpatient cost/case | Total cost/case | ||
---|---|---|---|---|---|
Mother | Mother | Infant | |||
Euglycemia | 43.7 | 1601.6 | 1150.3 | 2751.9 | 2795.6 |
GDM | 370.6 | 1835.0 | 1407.7 | 3242.8 | 3613.4 |
Diet (86%) | 262.5 | – | – | – | – |
Insulin (14%) | 1034.6 | – | – | – | – |
Delta | 326.9 | 233.4 | 257.4 | 490.9 | 817.8 |
Sensitivity analyses
Cost/case (euglycemia) | Cost/case (GDM) | ∆ cost/case | |
---|---|---|---|
Base case | 2751.8 | 3242.7 | 490.9 |
Costs (€)
| |||
Hypoglycemia | |||
−20% | 2734.9 | 3205.4 | 470.5 |
+ 20% | 2768.8 | 3280.0 | 511.2 |
Respiratory distress | |||
− 20% | 2691.6 | 3159.1 | 467.5 |
+ 20% | 2812.1 | 3326.3 | 514.2 |
Cesarean section with CC (GDM) | |||
− 20% | 2751.8 | 3215.0 | 463.2 |
+ 20% | 2751.8 | 3270.4 | 518.6 |
Cesarean section without CC (GDM) | |||
− 20% | 2751.8 | 3075.9 | 324.1 |
+ 20% | 2751.8 | 3409.5 | 657.7 |
Vaginal delivery without CC (GDM) | |||
− 20% | 2751.8 | 3090.3 | 338.5 |
+ 20% | 2751.8 | 3395.0 | 643.2 |
Cesarean section without CC (euglycemia) | |||
− 20% | 2611.4 | 3242.7 | 631.3 |
+ 20% | 2892.3 | 3242.7 | 350.4 |
Vaginal delivery without CC (euglycemia) | |||
− 20% | 2598.6 | 3242.7 | 644.1 |
+ 20% | 2905.1 | 3242.7 | 337.6 |
Probabilities
| |||
Hyperbilirubinemia (GDM/no macrosomia) | |||
− 20% | 2751.8 | 3199.1 | 447.3 |
+ 20% | 2751.8 | 3286.3 | 534.5 |
Hypoglycemia (GDM/no macrosomia) | |||
− 20% | 2751.8 | 3214.2 | 462.4 |
+ 20% | 2751.8 | 3271.2 | 519.4 |
Respiratory distress (GDM/no macrosomia) | |||
− 20% | 2751.8 | 3177.6 | 425.8 |
+ 20% | 2751.8 | 3307.8 | 556.0 |
Hyperbilirubinemia (euglycemia/no macrosomia) | |||
− 20% | 2713.2 | 3242.7 | 529.5 |
+ 20% | 2790.5 | 3242.7 | 452.2 |
Respiratory distress (euglycemia/no macrosomia) | |||
− 20% | 2699.0 | 3242.7 | 543.7 |
+ 20% | 2804.7 | 3242.7 | 438.0 |