Cost-effectiveness of interventions for screening, treatment, and management of diabetes mellitus during pregnancy: A systematic review.

BACKGROUND: Diabetes is the most common noncommunicable disease in pregnancy, and incidence is rising globally. This systematic review aimed to synthesize economic evidence on diverse interventions available for managing diabetes during pregnancy. METHODS: MEDLINE, Embase, CINAHL, PsycINFO, Global Index Medicus, and EconLit were searched from inception to November 30, 2024. Key terms related to pregnancy, diabetes mellitus, and economic evaluations were used. Studies were eligible for inclusion if they were full economic evaluations of any intervention for the screening, diagnosis, monitoring, or treatment of diabetes mellitus and/or its complications during pregnancy. Screening of studies, data extraction, and quality assessment (using the Consensus on Health Economic Criteria extended checklist) were conducted independently by two reviewers. RESULTS: Thirty-five studies were included and categorized as: screening and diagnosis (n = 18), diet and exercise (n = 2), fetal monitoring (n = 2), insulin and other glucose-lowering agents (n = 3), monitoring of blood glucose (n = 5), and multiple interventions (n = 5). Several interventions were found to be dominant compared to others, including oral glucose tolerance test (OGTT) over alternative screening tests (high quality), first-trimester fasting plasma glucose over third-trimester OGTT alone (high quality), hospital-based over primary care screening (moderate quality), continuous glucose monitoring over self-monitoring of blood glucose (high quality), metformin over standard care (high quality), insulin aspart over regular human insulin (moderate quality), and selective over universal fetal echocardiography (high quality). However, significant evidence gaps remain for several recommended interventions, underscoring the need for further economic evaluations to guide policy development and clinical decision-making. CONCLUSIONS: Several interventions for screening, diagnosing, and managing diabetes in pregnancy are likely to be cost-effective and can reduce health system costs. Further cost-effectiveness research is required to support the implementation of effective interventions, particularly in limited-resource settings.