Cost-effectiveness of healthy eating and/or physical activity promotion in pregnant women at increased risk of gestational diabetes mellitus: economic evaluation alongside the DALI study, a European multicenter randomized controlled trial
Por:
Broekhuizen, K, Simmons, D, Devlieger, R, van Assche, A, Jans, G, Galjaard, S, Corcoy, R, Adelantado, JM, Dunne, F, Desoye, G, Harreiter, J, Kautzky-Willer, A, Damm, P, Mathiesen, ER, Jensen, DM, Andersen, LL, Lapolla, A, Dalfra, MG, Bertolotto, A, Wender-Ozegowska, E, Zawiejska, A, Hill, D, Snoek, FJ, Jelsma, JGM, Bosmans, JE, van Poppel, MNM, van Dongen, JM
Publicada:
14 mar 2018
Resumen:
Background: Gestational diabetes mellitus (GDM) is associated with perinatal health risks to both mother and offspring, and represents a large economic burden. The DALI study is a multicenter randomized controlled trial, undertaken to add to the knowledge base on the effectiveness of interventions for pregnant women at increased risk for GDM. The purpose of this study was to evaluate the cost-effectiveness of the healthy eating and/or physical activity promotion intervention compared to usual care among pregnant women at increased risk of GDM from a societal perspective.
Methods: An economic evaluation was performed alongside a European multicenter-randomized controlled trial. A total of 435 pregnant women at increased risk of GDM in primary and secondary care settings in nine European countries, were recruited and randomly allocated to a healthy eating and physical activity promotion intervention (HE + PA intervention), a healthy eating promotion intervention (HE intervention), or a physical activity promotion intervention (PA intervention). Main outcome measures were gestational weight gain, fasting glucose, insulin resistance (HOMA-IR), quality adjusted life years (QALYs), and societal costs.
Results: Between-group total cost and effect differences were not significant, besides significantly less gestational weight gain in the HE + PA group compared with the usual care group at 35-37 weeks (-2.3; 95% CI:-3.7;-0.9). Cost-effectiveness acceptability curves indicated that the HE + PA intervention was the preferred intervention strategy. At 35-37 weeks, it depends on the decision-makers' willingness to pay per kilogram reduction in gestational weight gain whether the HE + PA intervention is cost-effective for gestational weight gain, whereas it was not cost-effective for fasting glucose and HOMA-IR. After delivery, the HE + PA intervention was cost-effective for QALYs, which was predominantly caused by a large reduction in delivery-related costs.
Conclusions: Healthy eating and physical activity promotion was found to be the preferred strategy for limiting gestational weight gain. As this intervention was cost-effective for QALYs after delivery, this study lends support for broad implementation.
Filiaciones:
Broekhuizen, K:
Vrije Univ Amsterdam, Dept Hlth Sci, Amsterdam, Netherlands
Vrije Univ Amsterdam, EMGO Inst Hlth & Care Res, Amsterdam, Netherlands
Simmons, D:
Western Sydney Univ, Campbelltown, NSW, Australia
Addenbrookes Hosp, Inst Metab Sci, Cambridge, England
Devlieger, R:
Katholieke Univ Leuven, Univ Hosp, Dept Dev & Regenerat Pregnancy Fetus & Neonate Gy, Leuven, Belgium
van Assche, A:
Katholieke Univ Leuven, Univ Hosp, Dept Dev & Regenerat Pregnancy Fetus & Neonate Gy, Leuven, Belgium
Jans, G:
Katholieke Univ Leuven, Univ Hosp, Dept Dev & Regenerat Pregnancy Fetus & Neonate Gy, Leuven, Belgium
Galjaard, S:
Katholieke Univ Leuven, Univ Hosp, Dept Dev & Regenerat Pregnancy Fetus & Neonate Gy, Leuven, Belgium
Univ Med Ctr Rotterdam, Erasmus MC, Dept Obstet & Gynaecol, Div Obstet & Prenatal Med, Rotterdam, Netherlands
Corcoy, R:
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Adelantado, JM:
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Inst Salud Carlos III, CIBER Bioengn Biomat & Nanotechnol, Zaragoza, Spain
Dunne, F:
Natl Univ Ireland, Galway Diabet Res Ctr, Galway, Ireland
Natl Univ Ireland, Coll Med Nursing & Hlth Sci, Galway, Ireland
Desoye, G:
Med Univ Graz, Dept Obstet & Gynecol, Graz, Austria
Harreiter, J:
Med Univ Vienna, Dept Internal Med 3, Gender Med Unit, Endocrinol & Metab, A-1090 Vienna, Austria
Kautzky-Willer, A:
Med Univ Vienna, Dept Internal Med 3, Gender Med Unit, Endocrinol & Metab, A-1090 Vienna, Austria
Damm, P:
Univ Copenhagen, Inst Clin Med, Fac Hlth & Med Sci, Rigshosp,Ctr Pregnant Women Diabet,Dept Endocrino, Copenhagen, Denmark
Univ Copenhagen, Inst Clin Med, Fac Hlth & Med Sci, Rigshosp,Ctr Pregnant Women Diabet,Dept Obstet, Copenhagen, Denmark
Mathiesen, ER:
Univ Copenhagen, Inst Clin Med, Fac Hlth & Med Sci, Rigshosp,Ctr Pregnant Women Diabet,Dept Endocrino, Copenhagen, Denmark
Univ Copenhagen, Inst Clin Med, Fac Hlth & Med Sci, Rigshosp,Ctr Pregnant Women Diabet,Dept Obstet, Copenhagen, Denmark
Jensen, DM:
Odense Univ Hosp, Dept Endocrinol, Odense, Denmark
Univ Southern Denmark, Fac Hlth Sci, Dept Clin Res, Odense, Denmark
Andersen, LL:
Odense Univ Hosp, Dept Endocrinol, Odense, Denmark
Odense Univ Hosp, Dept Gynecol & Obstet, Odense, Denmark
Univ Southern Denmark, Fac Hlth Sci, Dept Clin Res, Odense, Denmark
Lapolla, A:
Univ Padua, Padua, Italy
Dalfra, MG:
Univ Padua, Padua, Italy
Bertolotto, A:
Azienda Osped Univ Pisa, Pisa, Italy
Wender-Ozegowska, E:
Poznan Univ Med Sci, Med Fac, Poznan, Poland
Zawiejska, A:
Poznan Univ Med Sci, Med Fac, Poznan, Poland
Hill, D:
Rech Sante Lawson SA, Bronschhofen, Switzerland
Snoek, FJ:
Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Dept Med Psychol, Amsterdam, Netherlands
Acad Med Ctr, Dept Med Psychol, Amsterdam, Netherlands
Jelsma, JGM:
Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Dept Publ & Occupat Hlth, NL-1081 BT Amsterdam, Netherlands
Bosmans, JE:
Vrije Univ Amsterdam, Dept Hlth Sci, Amsterdam, Netherlands
Vrije Univ Amsterdam, EMGO Inst Hlth & Care Res, Amsterdam, Netherlands
van Poppel, MNM:
Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Dept Publ & Occupat Hlth, NL-1081 BT Amsterdam, Netherlands
Graz Univ, Inst Sport Sci, A-8010 Graz, Austria
van Dongen, JM:
Vrije Univ Amsterdam, Dept Hlth Sci, Amsterdam, Netherlands
Vrije Univ Amsterdam, EMGO Inst Hlth & Care Res, Amsterdam, Netherlands
Vrije Univ Amsterdam, Fac Earth & Life Sci, Dept Hlth Sci, De Boelelaan 1085, NL-1081 HV Amsterdam, Netherlands
Vrije Univ Amsterdam, Fac Earth & Life Sci, EMGO Inst Hlth & Care Res, De Boelelaan 1085, NL-1081 HV Amsterdam, Netherlands
Gold, Green Published
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