ABSTRACT

Background

This study estimated the cost-effectiveness of metformin to reduce the risk of gestational diabetes mellitus (GDM) in pregnant women with polycystic ovary syndrome (PCOS) from the US health-care payer perspective.

Methods

A decision tree was developed to simulate the progression of PCOS in a hypothetical cohort of 10,000 pregnant women diagnosed with PCOS and two scenarios were tested. Normal glucose regulation without developing GDM, average cost-effectiveness ratios (ACER), and the incremental cost-effectiveness ratios (ICERs) were the outcome measures assessed through pregnancy. Evidence from randomized clinical trials and other published literature were used to assess disease progression and its associated health-care costs. Sensitivity analyses that varied key model parameters were conducted.

Results

Management of PCOS with metformin was associated with lowest ACER ($669.78 per normal glucose regulation without GDM) as compared to ‘no intervention’ strategy. Metformin use is the most cost-effective strategy to manage PCOS during pregnancy with average cost savings of $7,593,372.97 and an average effect gain of 2271 of normal glucose regulation without GDM among pregnant women with PCOS. Sensitivity analyses determined that the results are robust.

Conclusions

Management of PCOS during pregnancy may be a cost-effective strategy to reduce GDM risk and its associated complications.

中文翻译：

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多囊卵巢综合征管理和妊娠期糖尿病风险的成本效益分析：决策树模型

摘要

背景

本研究从美国医疗保健支付者的角度评估了二甲双胍降低多囊卵巢综合征 (PCOS) 孕妇妊娠糖尿病 (GDM) 风险的成本效益。

方法

开发了一个决策树来模拟一个假设队列中 PCOS 的进展，该队列由 10,000 名诊断为 PCOS 的孕妇组成，并测试了两种情况。没有发生 GDM 的正常血糖调节、平均成本效益比 (ACER) 和增量成本效益比 (ICER) 是通过妊娠评估的结果指标。来自随机临床试验和其他已发表文献的证据被用于评估疾病进展及其相关的医疗保健费用。对不同的关键模型参数进行了敏感性分析。

结果

与“无干预”策略相比，二甲双胍治疗 PCOS 与最低 ACER 相关（无 GDM 的正常血糖调节为 669.78 美元）。使用二甲双胍是孕期管理 PCOS 最具成本效益的策略，在患有 PCOS 的孕妇中，平均可节省 7,593,372.97 美元的成本，在没有 GDM 的情况下正常血糖调节的平均效果增益为 2271。敏感性分析确定结果是稳健的。

结论

妊娠期 PCOS 的管理可能是降低 GDM 风险及其相关并发症的一种具有成本效益的策略。