Highlights
- •Although lifestyle intervention in pregnancy effectively reduces excess gestational weight gain and adverse pregnancy outcomes, limited research has yielded inconsistent findings on cost-effectiveness. It is also unclear which types of lifestyle interventions are the most cost-effective.
- •The meta-analysis on which this study is based has generated level 1 evidence of the efficacy of lifestyle interventions by intervention type in gestational weight gain and maternal and neonatal outcomes. The current cost-effectiveness study builds on this and shows that physical activity interventions appear cost saving and that diet and diet with physical activity interventions are likely to be cost-effective dependent on willingness-to-pay thresholds over a short time horizon and based on maternal pregnancy outcomes alone. Mixed interventions (lacking structured diet or physical activity intervention components) were not cost-effective. Scenario analysis, when diet-only, diet with physical activity, and physical activity-only interventions were analyzed, appeared cost saving. When neonatal intensive care unit costs were added to the model, all intervention types were cost saving except for mixed interventions.
- •These results favor implementing lifestyle interventions in pregnancy that incorporate structured diet and physical activity components at the population level.
Abstract
Objectives
Lifestyle interventions during pregnancy improve maternal and infant outcomes. We
aimed to compare the cost-effectiveness of 4 antenatal lifestyle intervention types
with standard care.
Methods
A decision tree model was constructed to compare lifestyle intervention effects from
a novel meta-analysis. The target population was women with singleton pregnancies
and births at more than 20 weeks’ gestation. Interventions were categorized as diet,
diet with physical activity, physical activity, and mixed (lacking structured diet
and, or, physical activity components). The outcome of interest was cost per case
prevented (gestational diabetes, hypertensive disorders in pregnancy, cesarean birth)
expressed as an incremental cost-effectiveness ratio (ICER) from the Australian public
healthcare perspective. Scenario analyses were included for all structured interventions
combined and by adding neonatal intensive care unit costs. Costs were estimated from
published data and consultations with experts and updated to 2019 values. Discounting
was not applied owing to the short time horizon.
Results
Physical activity interventions reduced adverse maternal events by 4.2% in the intervention
group compared with standard care and could be cost saving. Diet and diet with physical
activity interventions reduced events by 3.5% (ICER = A$4882) and 2.9% (ICER = A$2020),
respectively. Mixed interventions did not reduce events and were dominated by standard
care. In scenario analysis, all structured interventions combined and all interventions
when including neonatal intensive care unit costs (except mixed) may be cost saving.
Probabilistic sensitivity analysis showed that for physical activity and all structured
interventions combined, the probability of being cost saving was 58% and 41%, respectively.
Conclusions
Governments can expect a good return on investment and cost savings when implementing
effective lifestyle interventions population-wide.
Keywords
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Article Info
Publication History
Published online: September 18, 2021
Accepted:
July 20,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2021 ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc.
