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Objectives: Gestational diabetes mellitus (GDM) is associated with type 2 diabetes mellitus and adverse outcomes for both mothers and infants. Screening is a valuable method for identifying women at risk for GDM, and universal screening along with targeted screening is a key strategy for such identification. However, consensus is lacking regarding which GDM screening strategy is appropriate for pregnant women. Hence, the objective of this study was to compare the costeffectiveness of GDM screening strategies from the third payer perspective. Methods: A decision tree model was used to assess the costs and quality-adjusted life years (QALYs) for three GDM screening strategies: universal screening, targeted screening, and no screening. The Taiwan National Health Insurance Research Database and a literature review were used to estimate the model parameters. Sensitivity analysis was performed to evaluate the robustness of assessment. Results: Compared with the no screening strategy, universal screening and targeted screening were cost-effective. Universal screening was a cost-effective approach for decreasing the risks of GDM complications compared with targeted screening or no screening. Relative to targeted screening, universal screening generated an incremental cost-effectiveness ratio of $928/QALY gained. Sensitivity analysis provided similar results. Conclusions: Universal screening is a costeffective approach for improving maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]