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A Comparison of the Cost-Effectiveness of Lifestyle Interventions in Pregnancy

  • Cate Bailey
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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  • Helen Skouteris
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Warwick Business School, Warwick University, Coventry, England, UK
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  • Cheryce L. Harrison
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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  • Briony Hill
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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  • Shakila Thangaratinam
    Affiliations
    World Health Organization Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England, UK
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  • Author Footnotes
    ∗ Helena Teede and Zanfina Ademi contributed equally to this work and share joint senior authorship.
    Helena Teede
    Footnotes
    ∗ Helena Teede and Zanfina Ademi contributed equally to this work and share joint senior authorship.
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Monash Health Endocrine and Diabetes Units, Monash Health, Melbourne, Australia
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  • Author Footnotes
    ∗ Helena Teede and Zanfina Ademi contributed equally to this work and share joint senior authorship.
    Zanfina Ademi
    Correspondence
    Correspondence: Zanfina Ademi, PhD, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, 553 St Kilda Rd, Melbourne, Australia 3004.
    Footnotes
    ∗ Helena Teede and Zanfina Ademi contributed equally to this work and share joint senior authorship.
    Affiliations
    School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ Helena Teede and Zanfina Ademi contributed equally to this work and share joint senior authorship.
Published:September 18, 2021DOI:https://doi.org/10.1016/j.jval.2021.07.013

      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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