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Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review

  • Author Footnotes
    ∗ Weixin Li and Chi-Son Kim contributed equally to the article and should both be considered first author.
    Weixin Li
    Footnotes
    ∗ Weixin Li and Chi-Son Kim contributed equally to the article and should both be considered first author.
    Affiliations
    Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • Author Footnotes
    ∗ Weixin Li and Chi-Son Kim contributed equally to the article and should both be considered first author.
    Chi-Son Kim
    Footnotes
    ∗ Weixin Li and Chi-Son Kim contributed equally to the article and should both be considered first author.
    Affiliations
    Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, USA
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  • Elizabeth A. Howell
    Affiliations
    Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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  • Teresa Janevic
    Affiliations
    Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Blavatnik Family Women’s Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • Bian Liu
    Affiliations
    Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • Lizheng Shi
    Affiliations
    Department of Global Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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  • Yan Li
    Correspondence
    Correspondence: Yan Li, PhD, Departments of Population Health Science and Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, 1770 Madison Ave, Floor 2, Room 204, New York, NY 10035, USA.
    Affiliations
    Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Blavatnik Family Women’s Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Weixin Li and Chi-Son Kim contributed equally to the article and should both be considered first author.
Published:August 18, 2022DOI:https://doi.org/10.1016/j.jval.2022.07.014

      Highlights

      • Existing systematic reviews have confirmed the clinical effectiveness of many prenatal and postpartum interventions among women with gestational diabetes or hypertensive disorders of pregnancy.
      • This study adds to existing knowledge by systematically reviewing economic evaluations of prenatal and postpartum interventions among women with gestational diabetes or hypertensive disorders of pregnancy.
      • More high-quality economic evaluations of prenatal and postpartum interventions are needed to help healthcare decision makers optimize the allocation of limited resources to improve maternal health outcomes and curb increasing healthcare costs nationwide.

      Abstract

      Objectives

      This study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research.

      Methods

      Electronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list.

      Results

      Among the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP.

      Conclusions

      Existing economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.

      Keywords

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