Background: Hyperglycemia in pregnancy (HIP) imposes a substantial economic burden on individuals and their families, societies, healthcare systems, and nations worldwide. However, no systematic assessment of the economic impact of HIP has been conducted.
Objective: This study aimed to perform a systematic review of the economic burden of HIP.
Methods: Five electronic databases (Medline, Embase, Cinahl, Econlit, Psycinfo and Scopus) were searched for peer reviewed research articles reporting on the cost associated with HIP in English with no date restrictions. Information wasextracted using a predefined data extraction table. All the costs reported were converted to 2024 US dollars ($) and standardized into mean cost per person (or country) per year for comparison purpose. The quality of studies was assessed using an adapted version of previously developed Drummond’s quality checklist for cost of illness studies.
Results: A total of 28 studies were identified. Most focused on GDM (n= 22); only one study reported mild hyperglycemia. Most studies were from the United States (n = 12) and collected data since 2006 (n= 21). All studies adopted a prevalence-based epidemiological approach. Most were from the third-party payer perspective (n = 11). Eight studies estimated costs at the national level. Six articles were model-based analysis; 17 studies were observational. Cost analysis was the most common costing approach used (n = 27). Only one study was prospectively analysed; one included longitudinal costs at the patient level. Most studies (n=11) included costs related to mothers only; indirect costs were included in two studies. The annual national costs of HIP ranged from $636 million to $827 billion; the annual average cost per person ranged between “several hundred dollars” and $13,176. Neonatal care cost, followed by hospital inpatient cost and/or delivery cost, was the major contributor to total cost in studies that reported. The quality assessment identified methodological weaknesses in a few studies in terms of clearly stating perspectives and time horizons, sufficient disaggregation of cost components, separate reporting of quantities of utilized resources, performing incremental analyses, including sensitivity analyses for adjusting uncertainties, and discussing limitations.
Conclusion: There is a substantial variation in economic burden of HIP globally at both the patient and population levels. Future research may consider adopting consistent methodological approaches for more robust cost estimation and reporting to facilitate comparability and enhance the interpretation of findings across studies.
PROSPERO registration number: CRD42022340701