Cost-effectiveness of antenatal fetal surveillance for medication-treated gestational diabetes.

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Chloe Ramirez Biermann, Hannah Coggeshall, Gillian Luevano, G John Chen, Gene T Lee
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引用次数: 0

Abstract

Objective: To evaluate the relative cost-effectiveness of starting antenatal fetal surveillance at 32 vs. 36 weeks, in medication-treated gestational diabetes.

Methods: We performed a 2017-2022 retrospective cohort study of patients with medication-treated GDM who underwent BPPs. Patients diagnosed before 24 weeks, those delivered before 32 weeks, and those without BPPs or delivery data were excluded. Demographic and outcome data were abstracted by chart review. We performed a cost-effectiveness analysis regarding two outcomes: stillbirth, and decision to alter delivery timing following abnormal BPPs.

Results: A total of 652 pregnancies were included. Patients were 49% privately insured, 25% publicly insured, and 26% uninsured. We assumed that each BPP cost $145. In total, 1,284 BPPs occurred after 36 weeks, costing $186,180, and 2,041 BPPs occurred between 32 and 36 weeks, costing an additional $295,945. Twelve deliveries resulted from abnormal BPPs, all after 36 weeks. No stillbirths occurred. The cost to attempt to avoid one stillbirth was $40,177 across all patients. In our sample, starting surveillance at 36 weeks would have theoretically avoided all stillbirths, with cost savings per avoided stillbirth of $51,572 for privately insured patients, $14,123 for publicly insured patients, and $17,799 for patients without insurance.

Conclusion: Based on this population with no stillbirths and no BPPs dictating delivery before 36 weeks, surveillance after 36 weeks may be safe and cost-effective. Our findings reflect opportunities for shared decision making and potential practice change, with greatest impact for low socioeconomic status patients and those without insurance.

药物治疗妊娠糖尿病的产前胎儿监测成本效益。
目的:评估药物治疗妊娠糖尿病患者在 32 周和 36 周开始产前胎儿监护的相对成本效益:评估药物治疗的妊娠糖尿病患者在 32 周与 36 周开始产前胎儿监护的相对成本效益:我们对接受 BPP 的药物治疗 GDM 患者进行了一项 2017-2022 年回顾性队列研究。排除了 24 周前确诊的患者、32 周前分娩的患者以及无 BPPs 或分娩数据的患者。通过病历审查摘录了人口统计学和结果数据。我们对两种结果进行了成本效益分析:死胎和 BPP 异常后决定改变分娩时间:结果:共纳入了 652 例妊娠。患者中 49% 为私人保险,25% 为公共保险,26% 为无保险。我们假设每次 BPP 的费用为 145 美元。总共有 1,284 例 BPP 发生在 36 周之后,花费 186,180 美元,2,041 例 BPP 发生在 32 至 36 周之间,额外花费 295,945 美元。有 12 例因 BPP 异常而导致的分娩,全部发生在 36 周之后。没有死胎发生。在所有患者中,试图避免一个死胎的成本为 40177 美元。在我们的样本中,从 36 周开始监测理论上可以避免所有死胎的发生,每避免一个死胎可为私人保险患者节省 51,572 美元,为公共保险患者节省 14,123 美元,为无保险患者节省 17,799 美元:根据该人群无死胎且无 BPP 要求在 36 周前分娩的情况,在 36 周后进行监测可能是安全且具有成本效益的。我们的研究结果反映了共同决策和潜在实践变革的机会,对社会经济地位低和无保险的患者影响最大。
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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
217
审稿时长
2-3 weeks
期刊介绍: The official journal of The European Association of Perinatal Medicine, The Federation of Asia and Oceania Perinatal Societies and The International Society of Perinatal Obstetricians. The journal publishes a wide range of peer-reviewed research on the obstetric, medical, genetic, mental health and surgical complications of pregnancy and their effects on the mother, fetus and neonate. Research on audit, evaluation and clinical care in maternal-fetal and perinatal medicine is also featured.
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