Value in health regional issues · 2025
Cost Comparison of 2 Different Targets for Glycemic Control in Women With Gestational Diabetes: Evaluation From the TARGET Stepped-Wedge Randomized Trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Francis Susan E, Lin Luling, Edlin Richard P, Gamble Greg, Crowther Caroline A
Аннотация
OBJECTIVES: This study compared the costs of tight with less tight glycemic targets in the management of gestational diabetes using data from the TARGET trial.
METHODS: The TARGET trial included women with gestational diabetes from 10 District Health Boards in New Zealand. This economic evaluation assessed 2 glycemic control strategies: tight versus less tight targets. Data on healthcare resource use, including antenatal care, birth outcomes, and hospital stay, were collected and analyzed to identify cost differences. The analysis was conducted from the perspective of New Zealand's public healthcare system. The primary analysis adjusted for gestational age at the time of oral glucose tolerance test; additional analyses accounted for additional maternal and clinical factors.
RESULTS: There were no significant differences in total healthcare costs between the 2 glycemic target groups. After adjusting for gestational age at the time of oral glucose tolerance test, the mean difference in combined maternal and infant costs was $203 (95% CI 1074 to 1479, P = .76). Further adjustment for additional confounders showed a cost difference of -$59 (95% CI: -1318 to 1200; P = .93). Although total combined costs were slightly lower in the tight glycemic group, patterns of resource use varied, particularly in antenatal care and birth outcomes.
CONCLUSIONS: Tight glycemic control in gestational diabetes care does not result in higher healthcare costs. However, variations in resource use and birth outcomes warrant further investigation to optimize glycemic control strategies. Future research should explore the long-term impact of different glycemic targets and consider patient-centered outcomes to guide cost-effective policy decisions.
METHODS: The TARGET trial included women with gestational diabetes from 10 District Health Boards in New Zealand. This economic evaluation assessed 2 glycemic control strategies: tight versus less tight targets. Data on healthcare resource use, including antenatal care, birth outcomes, and hospital stay, were collected and analyzed to identify cost differences. The analysis was conducted from the perspective of New Zealand's public healthcare system. The primary analysis adjusted for gestational age at the time of oral glucose tolerance test; additional analyses accounted for additional maternal and clinical factors.
RESULTS: There were no significant differences in total healthcare costs between the 2 glycemic target groups. After adjusting for gestational age at the time of oral glucose tolerance test, the mean difference in combined maternal and infant costs was $203 (95% CI 1074 to 1479, P = .76). Further adjustment for additional confounders showed a cost difference of -$59 (95% CI: -1318 to 1200; P = .93). Although total combined costs were slightly lower in the tight glycemic group, patterns of resource use varied, particularly in antenatal care and birth outcomes.
CONCLUSIONS: Tight glycemic control in gestational diabetes care does not result in higher healthcare costs. However, variations in resource use and birth outcomes warrant further investigation to optimize glycemic control strategies. Future research should explore the long-term impact of different glycemic targets and consider patient-centered outcomes to guide cost-effective policy decisions.