Diabetes: gestational diabetes annual HbA1c test

Indicators

The percentage of women who have had gestational diabetes, diagnosed more than 12 months ago, who have had an HbA1c test in the preceding 12 months.

Introduction

Approximately 650,000 women give birth in England each year with 2% to 5%of pregnancies involving women with diabetes. An estimated 87.5% of pregnancies complicated by diabetes are due to gestational diabetes. Women with a history of gestational diabetes are at greater risk of developing type 2 diabetes later in life. The aim of this indicator is to improve the ongoing monitoring of women with a history of gestational diabetes and to ensure that those who go on to develop diabetes are identifieResource impact at 80% (cost of future practice less cost of current practice)d at early stage and offered appropriate treatment.

This statement covers a new indicator that is part of the NICE menu of general practice indicators, following the recommendations of the NICE indicator advisory committee in June 2017.

This statement considers the likely resource impact of the proposed indicator in terms of the number of additional blood tests carried out.

Resource impact

There are around 27.8 million women in England (see Office for National Statistics data 2016). It is estimated that around 0.4% of women have been previously diagnosed with gestational diabetes and that of these, 20% have an annual review including an HbA1c test (McGovern et al. 2014).

Assuming that achieving the indicator will need 5 minutes of practice nurse time (see Unit Costs of Health and Social Care 2016) to take blood samples for testing and a blood test to be carried out (see the Department of Health and Social Care NHS reference costs 2015 to 2016), the total unit cost per person is £6.

Table 1 shows estimated cost at achievement levels of 40% to 80%. These costs are not considered significant at a national level.

Table 1 Estimated annual cost of implementing indicator IND173

	Proportion	Population	Unit cost (£)	Total (£)
England population		54,786,327
Female population		27,757,041
Proportion previously diagnosed with gestational diabetes	0.43%	118,112
Current practice (proportion that have annual review including HbA1c test)	20%	23,622	6.00	141,700
Total cost of current practice				141,700
Future practice at 40% (achievement of indicator)	40%	47,245	6.00	283,500
Total cost of future practice				283,500
Resource impact at 40% (cost of future practice less cost of current practice)				141,800
Future practice at 80% (achievement of indicator)	80%	94,490	6.00	566,900
Total cost of future practice				566,900
Resource impact at 80% (cost of future practice less cost of current practice)				425,200