A new model-based pharmacoeconomic evaluation published in Cost Effectiveness and Resource Allocation concludes that probiotics are not a cost-effective treatment for gestational diabetes mellitus (GDM) when compared with placebo from the perspective of the Chinese healthcare system. The study, led by Rui Wu and Xinlian Zhong, utilized a decision-tree model to assess the economic viability of adding probiotics to standard GDM management. The central finding indicates that while probiotics may offer theoretical benefits related to gut microbiota, the marginal health gains do not justify the additional costs under current economic conditions in China.
Gestational diabetes mellitus is among the most common pregnancy complications, with its incidence increasing rapidly worldwide. Standard treatments typically involve lifestyle interventions and insulin therapy, which can be difficult for patients to maintain and are often costly. Because of the established role of gut microbiota in the pathophysiology of GDM, probiotics have been proposed as a potential therapeutic option to supplement or enhance standard care. This study aimed to evaluate whether incorporating probiotics into GDM management in China would be economically favorable compared to using a placebo.
The researchers performed a cost-effectiveness analysis using a decision-tree model built in TreeAge Pro software. The model compared two strategies: the administration of probiotics versus a placebo following the diagnosis of GDM. The analysis was conducted from the Chinese healthcare system perspective with a short-term time horizon corresponding to the eight-week treatment period. The study explicitly notes that this analysis should be interpreted as an acute-treatment economic evaluation rather than a comprehensive lifetime cost-effectiveness analysis, as it does not capture long-term maternal or offspring outcomes. No discounting was applied to the costs or outcomes due to the short time frame of the model.
The model incorporated several key health states, including GDM complications, preterm birth, and neonatal death. Probabilities, utilities, and costs were obtained from meta-analyses and national pharmacoeconomic data to ensure the inputs reflected current evidence and local economic conditions. The incremental cost-effectiveness ratio (ICER) was calculated and compared against a willingness-to-pay (WTP) threshold of ¥257,094 per QALY, which serves as the benchmark for determining cost-effectiveness in this context.
The results showed that the probiotic strategy resulted in an average total cost of ¥2,119.29 and 0.14997 QALYs. In comparison, the placebo strategy cost ¥1,687.90 and provided 0.14996 QALYs. The difference in health outcomes between the two strategies was extremely small, amounting to only 0.00001 QALYs. This minute difference is equivalent to approximately 5.3 quality-adjusted life minutes, reflecting the short treatment duration and the limited health utility gains captured in the model. The incremental cost of the probiotic strategy was therefore very high relative to the negligible gain in health outcomes.
Consequently, the calculated ICER was ¥65,400,488 per QALY. This value far exceeds the willingness-to-pay threshold of ¥257,094 per QALY, demonstrating that probiotics are not cost-effective compared with placebo in this specific modeling scenario. The extremely high ICER arises primarily from the very small QALY difference between the strategies. The study authors emphasize that this finding is specific to the acute treatment period modeled and does not necessarily reflect the long-term economic or health impacts of probiotic use in GDM management.
To test the robustness of these findings, the researchers conducted one-way and probabilistic sensitivity analyses. These analyses confirmed the stability of the results, indicating that the conclusion of non-cost-effectiveness was not driven by specific parameter assumptions within the tested ranges. However, the authors acknowledge that the conclusion is subject to uncertainty stemming from the limited utility gain captured in the model and the short-term modeling assumptions. The model does not account for potential long-term benefits or harms that might emerge beyond the eight-week treatment window.
The study suggests that future research should evaluate long-term effects, species-specific outcomes, and regional utility values to refine policy decisions regarding probiotic use in GDM. By focusing on a short-term, acute treatment perspective, this evaluation provides a specific economic snapshot that may differ from broader lifetime analyses.
Subject of Research: Cost-effectiveness of probiotics for gestational diabetes mellitus in China
Article Title: Cost-effectiveness analysis of probiotics in patients with gestational diabetes mellitus: a model‑based pharmacoeconomic evaluation from the Chinese healthcare perspective
Article References: Wu, R., & Zhong, X. (2026). Cost-effectiveness analysis of probiotics in patients with gestational diabetes mellitus: a model‑based pharmacoeconomic evaluation from the Chinese healthcare perspective. Cost Effectiveness and Resource Allocation. https://doi.org/10.1186/s12962-026-00819-9
Image Credits: AI Generated
DOI: 10.1186/s12962-026-00819-9
Keywords: gestational diabetes, probiotics, cost-effectiveness, pharmacoeconomics, Chinese healthcare, QALYs, decision-tree model, pregnancy complications, analysis, patients, gestational, diabetes
