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

• Published in: Value in health 2022-02, Vol.25 (2), p.194-202
• Main Authors: Bailey, Cate, Skouteris, Helen, Harrison, Cheryce L., Hill, Briony, Thangaratinam, Shakila, Teede, Helena, Ademi, Zanfina
• Format: Article
• Language: English
• Subjects: Adult; Australia; Cesarean Section - statistics & numerical data; Cost-Benefit Analysis; cost-effectiveness; decision tree model; Diabetes, Gestational - prevention & control; diet; Diet - methods; Exercise; Female; gestational diabetes mellitus; Health Promotion - economics; Humans; Hypertension, Pregnancy-Induced - prevention & control; hypertensive disorders in pregnancy; Infant, Newborn; Intensive Care Units, Neonatal - statistics & numerical data; intervention; Life Style; lifestyle interventions; physical activity; Pregnancy; Pregnancy Complications - prevention & control
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2021.07.013

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. 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. 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. Governments can expect a good return on investment and cost savings when implementing effective lifestyle interventions population-wide. •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