Women of advanced maternal age (AMA) are at increased risk of diabetes in pregnancy. Screening for impaired fasting glucose in the first trimester can result in earlier diagnosis and treatment of pre-existing glucose intolerance. Our study examined the cost-effectiveness of first trimester fasting plasma glucose (FPG) screening in AMA women.METHODS:
A decision analysis model was created using TreeAge2017 software to compare pregnancy outcomes between AMA women who undergo a first trimester FPG screen versus those who undergo second trimester screening alone. Outcomes examined included intrauterine fetal demise, preeclampsia, preterm delivery, neonatal death, cerebral palsy, cost, and quality adjusted life years (QALYs) of the mother and neonate. Probabilities, utilities, and costs were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Univariate analyses were used to investigate the impact of screening positivity.RESULTS:
In a theoretical cohort of 10,000 AMA women, first trimester FPG screening was cost-saving, more effective and more cost-effective than traditional second trimester screening alone, with a cost-effectiveness ratio of $59.96 per QALY. Earlier detection resulted in lower incidence of preeclampsia and fewer preterm deliveries, intrauterine fetal demises, and neonatal deaths. Using a threshold of $100,000 per QALY, sensitivity analysis revealed that early screening was effective even when the cost of screening is increased 300-fold or the incremental cost of initiating diabetes treatment in the first trimester is increased 200-fold.CONCLUSION:
First trimester FPG screening in advanced maternal age is cost-effective and allows for earlier diagnosis, treatment, and improved neonatal outcomes compared to second trimester screening alone.