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The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial

Dodd, Jodie M, Ahmed, Sharmina, Karnon, Jonathan, Umberger, Wendy, Deussen, Andrea R, Tran, Thach, Grivell, Rosalie M, Crowther, Caroline A, Turnbull, Deborah, McPhee, Andrew J, Wittert, Gary, Owens, Julie A, Robinson, Jeffrey S, Dodd, JM, Turnbull, D, McPhee, A, Grivell, RM, Crowther, C, Gillman, M, Wittert, G, Owens, JA, Robinson, JS, Dodd, JM, Deussen, A, Grivell, RM, Yelland, L, Moran, L, Cramp, C, Newman, A, Kannieappian, L, Hendrijanto, S, Kelsey, M, Beaumont, J, Danz, C, Koch, J, Webber, A, Holst, C, Robinson, K, Zhang, S, Ball, V, Ball, Kylie, Deussen, H, Salehi, N, Bartley, R, Stafford-Green, R, Ophel, S, Cooney, M, Szmeja, M, Short, A, Melrose, A, Han, S, Mohamad, I, Chapple, L, Grivell, RM, Svigos, J, Bhatia, V, Manton, N, Dodd, JM, Turnbull, D, McPhee, A, Deussen, A, Grivell, RM and Yelland, L 2015, The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial, BMC obesity, vol. 2, pp. 1-9, doi: 10.1186/s40608-015-0046-4.

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Title The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial
Author(s) Dodd, Jodie M
Ahmed, Sharmina
Karnon, Jonathan
Umberger, Wendy
Deussen, Andrea R
Tran, Thach
Grivell, Rosalie M
Crowther, Caroline A
Turnbull, Deborah
McPhee, Andrew J
Wittert, Gary
Owens, Julie A
Robinson, Jeffrey S
Dodd, JM
Turnbull, D
McPhee, A
Grivell, RM
Crowther, C
Gillman, M
Wittert, G
Owens, JA
Robinson, JS
Dodd, JM
Deussen, A
Grivell, RM
Yelland, L
Moran, L
Cramp, C
Newman, A
Kannieappian, L
Hendrijanto, S
Kelsey, M
Beaumont, J
Danz, C
Koch, J
Webber, A
Holst, C
Robinson, K
Zhang, S
Ball, V
Ball, KylieORCID iD for Ball, Kylie orcid.org/0000-0003-2893-8415
Deussen, H
Salehi, N
Bartley, R
Stafford-Green, R
Ophel, S
Cooney, M
Szmeja, M
Short, A
Melrose, A
Han, S
Mohamad, I
Chapple, L
Grivell, RM
Svigos, J
Bhatia, V
Manton, N
Dodd, JM
Turnbull, D
McPhee, A
Deussen, A
Grivell, RM
Yelland, L
Journal name BMC obesity
Volume number 2
Article ID 14
Start page 1
End page 9
Total pages 9
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2015-03-11
ISSN 2052-9538
Keyword(s) pregnancy
overweight and obesity
health economics evaluation
cost effectiveness analysis
randomised trial
dietary and lifestyle intervention
Summary Background: Overweight 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+0weeks, and BMI ≥ 25 kg/m2were 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.

Results: Overall, 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.

Conclusions: Providing 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.
Language eng
DOI 10.1186/s40608-015-0046-4
Copyright notice ©2015, Dodd et al.
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30110119

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.