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Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: results of an economic evaluation alongside a randomised controlled trial.

Oostdam N, Bosmans J, Wouters MG, Eekhoff EM, van Mechelen W, van Poppel MN - BMC Pregnancy Childbirth (2012)

Bottom Line: Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios.There were no statistically significant differences in any outcome measure.During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.

ABSTRACT

Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM and the risks associated with GDM lead to increased health care costs and losses in productivity. The objective of this study is to evaluate whether the FitFor2 exercise program during pregnancy is cost-effective from a societal perspective as compared to standard care.

Methods: A randomised controlled trial (RCT) and simultaneous economic evaluation of the FitFor2 program were conducted. Pregnant women at risk for GDM were randomised to an exercise program to prevent high maternal blood glucose (n = 62) or to standard care (n = 59). The exercise program consisted of two sessions of aerobic and strengthening exercises per week. Clinical outcome measures were maternal fasting blood glucose levels, insulin sensitivity and infant birth weight. Quality of life was measured using the EuroQol 5-D and quality-adjusted life-years (QALYs) were calculated. Resource utilization and sick leave data were collected by questionnaires. Data were analysed according to the intention-to-treat principle. Missing data were imputed using multiple imputations. Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios.

Results: There were no statistically significant differences in any outcome measure. During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204). The cost-effectiveness analyses showed that the exercise program was not cost-effective in comparison to the control group for blood glucose levels, insulin sensitivity, infant birth weight or QALYs.

Conclusion: The twice-weekly exercise program for pregnant women at risk for GDM evaluated in the present study was not cost-effective compared to standard care. Based on these results, implementation of this exercise program for the prevention of GDM cannot be recommended.

Trial registration: NTR1139.

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Related in: MedlinePlus

(A) CE plane and (B) CEA curve for outcome maternal fasting blood glucose (multiple imputed data).
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Figure 1: (A) CE plane and (B) CEA curve for outcome maternal fasting blood glucose (multiple imputed data).

Mentions: Figure 1 shows the CE plane for the intervention versus control group for outcome of maternal fasting blood glucose at 32 weeks of gestation. The ICER for the outcome maternal fasting blood glucose was −46,971 (Table 3), meaning that to gain one point of improvement in blood glucose in the intervention group compared with the control group was associated with €46,971 higher costs. This ICER is too high to allow for meaningful interpretation. The CE plane for the outcome maternal fasting blood glucose at 32 weeks of gestation confirms the findings that there were no significant differences in total costs or blood glucose levels between the intervention and control group.


Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: results of an economic evaluation alongside a randomised controlled trial.

Oostdam N, Bosmans J, Wouters MG, Eekhoff EM, van Mechelen W, van Poppel MN - BMC Pregnancy Childbirth (2012)

(A) CE plane and (B) CEA curve for outcome maternal fasting blood glucose (multiple imputed data).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475114&req=5

Figure 1: (A) CE plane and (B) CEA curve for outcome maternal fasting blood glucose (multiple imputed data).
Mentions: Figure 1 shows the CE plane for the intervention versus control group for outcome of maternal fasting blood glucose at 32 weeks of gestation. The ICER for the outcome maternal fasting blood glucose was −46,971 (Table 3), meaning that to gain one point of improvement in blood glucose in the intervention group compared with the control group was associated with €46,971 higher costs. This ICER is too high to allow for meaningful interpretation. The CE plane for the outcome maternal fasting blood glucose at 32 weeks of gestation confirms the findings that there were no significant differences in total costs or blood glucose levels between the intervention and control group.

Bottom Line: Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios.There were no statistically significant differences in any outcome measure.During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.

ABSTRACT

Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM and the risks associated with GDM lead to increased health care costs and losses in productivity. The objective of this study is to evaluate whether the FitFor2 exercise program during pregnancy is cost-effective from a societal perspective as compared to standard care.

Methods: A randomised controlled trial (RCT) and simultaneous economic evaluation of the FitFor2 program were conducted. Pregnant women at risk for GDM were randomised to an exercise program to prevent high maternal blood glucose (n = 62) or to standard care (n = 59). The exercise program consisted of two sessions of aerobic and strengthening exercises per week. Clinical outcome measures were maternal fasting blood glucose levels, insulin sensitivity and infant birth weight. Quality of life was measured using the EuroQol 5-D and quality-adjusted life-years (QALYs) were calculated. Resource utilization and sick leave data were collected by questionnaires. Data were analysed according to the intention-to-treat principle. Missing data were imputed using multiple imputations. Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios.

Results: There were no statistically significant differences in any outcome measure. During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204). The cost-effectiveness analyses showed that the exercise program was not cost-effective in comparison to the control group for blood glucose levels, insulin sensitivity, infant birth weight or QALYs.

Conclusion: The twice-weekly exercise program for pregnant women at risk for GDM evaluated in the present study was not cost-effective compared to standard care. Based on these results, implementation of this exercise program for the prevention of GDM cannot be recommended.

Trial registration: NTR1139.

Show MeSH
Related in: MedlinePlus