Cost-effectiveness of a diabetes detection program in childbearing women to prevent malformations

Abstract

Background: In Chile, in the next 20 years there will be an average number of 537,100 women of childbearing age with type 2 diabetes (T2DM). Half of these women, not knowing their diagnosis of diabetes will become pregnant with elevated glycosylated hemoglobin levels, increasing to 25% the risk of having offspring with congenital malformations. Aim: To calculate the cost-effectiveness of a diabetes detection strategy in women of childbearing age for the prevention of congenital malformations in the period 2020-2039. Material and Methods: The Markov stochastic model was used in two scenarios, namely A: No intervention and B: Intervention, detecting T2DM in Chilean women aged 15-49 years. We calculated the years of life lost due to premature death (YLL), years of life lost adjusted for disability (DALY) and total costs using American dollars (US$) of 2017, with a discount rate of 5%. Results: In scenario A: 63,330 children with malformations would be born, YLLs and DALYs would be 800,750 and 1,544,775 respectively, and US$ 10,194,298,011 would be expended. In scenario B, these figures would be reduced in approximately 70% to 19,025 children born with malformations, YLLS and DALYs would be 40,539 and 464,033 respectively and US$ 3,354,321,968 would be expended. The costs of prevention would be US$ 6,590.94/malformation avoided, US$ 521.33/YLL avoided, and US$ 270.24/ DALY avoided. Conclusions: In the context of an increasing prevalence of diabetes in women of childbearing age, our results suggest that the early detection of diabetes in Chilean women between 15 and 49 years of age, should be cost-effective to avoid an increase in congenital malformations for the next 20 years.