Long-term Cost-effectiveness of Implementing a Lifestyle Intervention During Pregnancy to Reduce the Incidence of Gestational Diabetes and Type 2 Diabetes

Overview

Journal Diabetologia

Specialty Endocrinology

Date 2023 Mar 18

PMID 36932207

Authors

Melanie Lloyd

Jedidiah Morton

Helena Teede

Clara Marquina

Dina Abushanab

Dianna J Magliano

Emily J Callander

Zanfina Ademi

Affiliations

Soon will be listed here.

Abstract

Aims/hypothesis: The aim of this study was to determine the long-term cost-effectiveness and return on investment of implementing a structured lifestyle intervention to reduce excessive gestational weight gain and associated incidence of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus.

Methods: A decision-analytic Markov model was used to compare the health and cost-effectiveness outcomes for (1) a structured lifestyle intervention during pregnancy to prevent GDM and subsequent type 2 diabetes; and (2) current usual antenatal care. Life table modelling was used to capture type 2 diabetes morbidity, mortality and quality-adjusted life years over a lifetime horizon for all women giving birth in Australia. Costs incorporated both healthcare and societal perspectives. The intervention effect was derived from published meta-analyses. Deterministic and probabilistic sensitivity analyses were used to capture the impact of uncertainty in the model.

Results: The model projected a 10% reduction in the number of women subsequently diagnosed with type 2 diabetes through implementation of the lifestyle intervention compared with current usual care. The total net incremental cost of intervention was approximately AU$70 million, and the cost savings from the reduction in costs of antenatal care for GDM, birth complications and type 2 diabetes management were approximately AU$85 million. The intervention was dominant (cost-saving) compared with usual care from a healthcare perspective, and returned AU$1.22 (95% CI 0.53, 2.13) per dollar invested. The results were robust to sensitivity analysis, and remained cost-saving or highly cost-effective in each of the scenarios explored.

Conclusions/interpretation: This study demonstrates significant cost savings from implementation of a structured lifestyle intervention during pregnancy, due to a reduction in adverse health outcomes for women during both the perinatal period and over their lifetime.

Citing Articles

Early Mediterranean-Based Nutritional Intervention Reduces the Rate of Gestational Diabetes in Overweight and Obese Pregnant Women: A Post-Hoc Analysis of the San Carlos Gestational Prevention Study.

Martin-OConnor R, Ramos-Levi A, Melero V, Arnoriaga-Rodriguez M, Barabash A, Valerio J Nutrients. 2024; 16(14).

PMID: 39064649 PMC: 11279464. DOI: 10.3390/nu16142206.

A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study.

OReilly S, Laws R, Maindal H, Teede H, Harrison C, McAuliffe F JMIR Res Protoc. 2023; 12:e51431.

PMID: 37721798 PMC: 10546269. DOI: 10.2196/51431.

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