Oral Antihyperglycemic Agents Versus Insulin for Gestational Diabetes Mellitus: Societal Cost‐Effectiveness Analysis of the
SUGAR
‐
DIP
Randomized C
Hana M. Broulikova, Anne W. T. van der Wel, Doortje Rademaker, Leon de Wit, Ruben G. Duijnhoven, Daphne N. Voormolen, Joris A. M. van der Post, Ben Willem Mol, Arie Franx, J. Hans DeVries, Bas B. van Rijn, Judith E. Bosmans, Rebecca C. Painter, ABSTRACT
Objective
To assess the cost‐effectiveness of treatment with sequential oral antihyperglycemic agents (OHA; metformin and glibenclamide) versus insulin for gestational diabetes (GDM).
Design
Cost‐effectiveness analysis from a societal and healthcare perspective alongside a randomized controlled trial (SUGAR‐DIP).
Setting
Twenty‐five hospitals in the Netherlands.
Population
Women with GDM and a singleton pregnancy, randomized to OHA ( n = 409) or insulin ( n = 411) between 16 to 34 weeks' gestation.
Methods
Missing data were handled using multiple imputation. Differences in costs and effects were estimated using bivariate regression with bootstrapping to derive incremental cost‐effectiveness ratios. Cost‐effectiveness acceptability curves were constructed across a range of willingness‐to‐pay (WTP) thresholds.
Main Outcome Measures
Large for gestational age (LGA), quality‐adjusted life‐years (QALYs), costs and cost‐effectiveness.
Results
OHA slightly increased QALYs (0.009; 95% CI 0.004 to 0.014), corresponding to approximately 3 days in perfect health. There were no statistically significant differences in LGA avoided (−0.039; 95% CI−0.097 to 0.018) or societal costs (mean difference−€1004; 95% CI−€3503 to €1495). OHA were less costly and less effective than insulin for LGA, whereas for QALYs they were less costly and more effective. The probability of OHA being cost‐effective at a WTP threshold of €0 was 79% for both outcomes.
Conclusions
OHA have a high probability of being cost‐effective compared with insulin for QALYs, although the QALY gain is small and of limited clinical relevance. For LGA, OHA were less costly but less effective, and cost‐effectiveness depends on acceptable trade‐offs between costs and neonatal outcomes.