Purpose: The HAPO study demonstrated a linear relationship between maternal hyperglycemia and adverse pregnancy outcomes. Subjects were divided into seven categories according to fasting glucose levels, with Category 5 representing the top 3-12% who would likely be diagnosed with gestational diabetes (GDM) under the new IADPSG guidelines. This study examines the cost-effectiveness of treating patients in HAPO Category 5 for GDM, accounting for the costs and benefits of treating hyperglycemia in pregnancy.
Methods: A decision analytic model was built using TreeAge software that compared treatment vs. no treatment for patients in HAPO Category 5. Outcomes included preeclampsia, mode of delivery, maternal death, macrosomia, shoulder dystocia, brachial plexus injury (permanent and transient), hypoglycemia, hyperbilirubinemia, and neonatal death. Existing randomized controlled trials were used to estimate the effect of treatment on outcomes. Utilities were applied to discounted life expectancy at a discount rate of 3% to generate QALYs. In addition, an index adjusting for treatment efficacy was used for sensitivity analysis. The cost-effectiveness threshold was set to $100,000 per QALY.
Results: Treating patients in HAPO Category 5 was the dominant strategy. Treatment was more expensive ($12,661.81 with treatment vs $11,843.64 without treatment) but more effective (56.914924 QALYs with treatment vs 56.897791 without treatment), with an incremental cost of $47754.04/QALY. In a one-way sensitivity of analysis of the degree of treatment efficacy, treatment remained cost-effective as long as it met 67% of its reported efficacy.
Conclusion: Treating patients in Glucose Category 5 of the HAPO Trial is cost-effective in terms of improving maternal and neonatal outcomes. How the health care system will provide this expanded care to this group of women will need to be examined. 
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