Abstract
BackgroundOverweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking.We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10+0-20+0 weeks, and BMI ≥25 kg/m2 were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Analyses utilised intention to treat principles.ResultsOverall, the increase in mean costs associated with providing the intervention was offset by savings associated with improved immediate neonatal outcomes, rendering the intervention cost neutral (Lifestyle Advice Group $11261.19±$14573.97 versus Standard Care Group $11306.70±$14562.02; p=0.094). Using a monetary value of $20,000 as a threshold value for avoiding an additional infant with birth weight above 4 kg, the probability that the antenatal intervention is cost-effective is 0.85, which increases to 0.95 when the threshold monetary value increases to $45,000.ConclusionsProviding an antenatal dietary and lifestyle intervention for pregnant women who are overweight or obese is not associated with increased costs or cost savings, but is associated with a high probability of cost effectiveness. Ongoing participant follow-up into childhood is required to determine the medium to long-term impact of the observed, short-term endpoints, to more accurately estimate the value of the intervention on risk of obesity, and associated costs and health outcomes.Trials registrationAustralian and New Zealand Clinical Trials Registry (ACTRN12607000161426).
Highlights
Overweight and obesity during pregnancy is common, robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking
There were no statistically significant differences in the baseline characteristics of women randomised between the two treatment groups (Table 2) [27], or in health service encounters, with the exception of visits to the diabetes educator which were increased in women receiving Lifestyle Advice (Table 3)
As reported previously, infants born to women following lifestyle advice were significantly less likely to have birth weight above 4.0 kg (Lifestyle Advice 164/1075 (15.22%) versus Standard Care 201/1067 (18.79%); aRR 0.82; 95% CI 0.68 to 0.99; Number Needed to Treat (NNT) 28; 95% CI 15 to 263; p = 0.04) [27]
Summary
Overweight and obesity during pregnancy is common, robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. Women with a singleton pregnancy, between 10+0-20+0 weeks, and BMI ≥25 kg/m2 were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Data from the United States indicate $147 billion dollars, or 10% of the country’s total health care expenditure was spent on treatment of obesity related complications in 2006 [10], with projections indicating a doubling of costs each decade, representing up to 18% of total health-care expenditure by 2030 [11]
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