{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T13:10:19Z","timestamp":1762693819326,"version":"build-2065373602"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010414","name":"Health Research Board","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010414","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate the cost\u2010effectiveness of early initiation of metformin and usual care for gestational diabetes mellitus (GDM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Economic evaluation from a healthcare perspective, based on the\n                      <jats:styled-content style=\"fixed-case\">EMERGE<\/jats:styled-content>\n                      randomised controlled trial. In total, 535 women with\n                      <jats:styled-content style=\"fixed-case\">GDM<\/jats:styled-content>\n                      were randomised to placebo in addition to usual care or metformin in addition to usual care. Economic outcomes included incremental healthcare costs and quality adjusted life years (\n                      <jats:styled-content style=\"fixed-case\">QALYs<\/jats:styled-content>\n                      ) and expected cost\u2010effectiveness at cost\u2010effectiveness threshold values of \u20ac20,000, \u20ac45,000 and \u20ac100,000 per\n                      <jats:styled-content style=\"fixed-case\">QALY<\/jats:styled-content>\n                      gained. Uncertainty was explored using parametric, non\u2010parametric, deterministic and probabilistic methods and heterogeneity using subgroup analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      On average, relative to the placebo arm, the early metformin arm was associated with non\u2010statistically significant mean increases of \u20ac193.07 (95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      : \u2212\u20ac789.88, \u20ac1176.01;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.700) and 0.002\n                      <jats:styled-content style=\"fixed-case\">QALYs<\/jats:styled-content>\n                      (95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      : \u22120.009, 0.013;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.771). In terms of expected cost\u2010effectiveness at threshold values of \u20ac20,000, \u20ac45,000 and \u20ac100,000 per\n                      <jats:styled-content style=\"fixed-case\">QALY<\/jats:styled-content>\n                      gained, the probability of the early metformin arm being more cost\u2010effective was estimated at 0.423, 0.452 and 0.524. Exploratory subgroup analyses provided more favourable but not definitive evidence in favour of the early metformin arm for cohorts with previous\n                      <jats:styled-content style=\"fixed-case\">GDM<\/jats:styled-content>\n                      and previous caesarean section.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      We do not find definitive evidence that early initiation of metformin in addition to usual care for\n                      <jats:styled-content style=\"fixed-case\">GDM<\/jats:styled-content>\n                      was more cost\u2010effective than usual care alone. The clinical and economic evidence may be considered equivocal, but worthy of further examination.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70036","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T08:41:28Z","timestamp":1743756088000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost effectiveness of early metformin in addition to usual care in the reduction of gestational diabetes mellitus effects (\n                    <scp>EMERGE<\/scp>\n                    )\u2014A randomised placebo\u2010controlled clinical trial"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6297-9478","authenticated-orcid":false,"given":"Paddy","family":"Gillespie","sequence":"first","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronan","family":"Mahon","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6712-3668","authenticated-orcid":false,"given":"Christine","family":"Newman","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Alvarez\u2010Iglesias","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Ferguson","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Smyth","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"O'Shea","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Declan","family":"Devane","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0379-9279","authenticated-orcid":false,"given":"Aoife","family":"Egan","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"},{"name":"Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"O'Donnell","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fidelma","family":"Dunne","sequence":"additional","affiliation":[{"name":"University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Organisation WH.Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy.2013."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107841"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-011-2150-4"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0461"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12678"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101294"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60731-5"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1646"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902430"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042973"},{"issue":"1","key":"e_1_2_11_13_1","first-page":"S232","article-title":"15. 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