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Health Economics

Cost-effectiveness of a mobile health-supported lifestyle intervention for pregnant women with an elevated body mass index

International Journal of Obesity volume 44, pages 999–1010 (2020)Cite this article

Subjects

Abstract

Objective

To assess the cost-effectiveness of a mobile health-supported lifestyle intervention compared with usual care.

Methods

We conducted a cost-effectiveness analysis from the perspective of the publicly-funded health care system. We estimated costs associated with the intervention and health care utilisation from first antenatal care appointment through delivery. We used bootstrap methods to quantify the uncertainty around cost‐effectiveness estimates. Health outcomes assessed in this analysis were gestational weight gain (GWG; kg), incidence of excessive GWG, quality-adjusted life years (QALYs), and incidence of large-for-gestational-age (LGA). Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained, cost per kg of GWG avoided, cost per case of excessive GWG averted, and cost per case of LGA averted.

Results

Total mean cost including intervention and health care utilisation was €3745 in the intervention group and €3471 in the control group (mean difference €274, P = 0.08). The ICER was €2914 per QALY gained. Assuming a ceiling ratio of €45,000, the probability that the intervention was cost‐effective based on QALYs was 79%. Cost per kg of GWG avoided was €209. The cost-effectiveness acceptability curve (CEAC) for kg of GWG avoided reached a confidence level of 95% at €905, indicating that if one is willing to pay a maximum of an additional €905 per kg of GWG avoided, there is a 95% probability that the intervention is cost-effective. Costs per case of excessive GWG averted and case of LGA averted were €2117 and €5911, respectively. The CEAC for case of excessive GWG averted and for case of LGA averted reached a confidence level of 95% at €7090 and €25,737, respectively.

Conclusions

Results suggest that a mobile-health lifestyle intervention could be cost-effective; however, a better understanding of the short- and long-term costs of LGA and excessive GWG is necessary to confirm the results.

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Fig. 1: Cost-effectiveness plane (top) and acceptability curve (bottom) for quality-adjusted life years (QALYs).
Fig. 2: Cost-effectiveness plane (top) and acceptability curve (bottom) for gestational weight gain (GWG).
Fig. 3: Cost-effectiveness plane (top) and acceptability curve (bottom) for case of large-for-gestational age (LGA).

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Funding

The PEARs trial received funding from The National Maternity Hospital Medical Fund (Dublin, Ireland) and University College Dublin (Ireland), the authors received no additional funding to conduct the present analysis.

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Author notes

  1. Slawa Rokicki

    Present address: Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, United States

  2. These authors contributed equally as joint first authors: Elizabeth J. O’Sullivan, Slawa Rokicki

Authors and Affiliations

  1. UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital Ireland, Dublin, Ireland

    Elizabeth J. O’Sullivan, Maria Kennelly, Kate Ainscough & Fionnuala M. McAuliffe

  2. School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland

    Elizabeth J. O’Sullivan

  3. Geary Institute for Public Policy, University College Dublin, Dublin, Ireland

    Slawa Rokicki

Authors
  1. Elizabeth J. O’Sullivan
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  4. Kate Ainscough
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  5. Fionnuala M. McAuliffe
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Contributions

EJOS and SR were involved in the conception, planning, carrying out, interpreting and writing up of the work. SR conducted cost-effectiveness analyses. MK and KA were involved in the conception and writing up of the work. FMcA oversaw all aspects of the work and is responsible for the final content.

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Correspondence to Fionnuala M. McAuliffe.

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O’Sullivan, E.J., Rokicki, S., Kennelly, M. et al. Cost-effectiveness of a mobile health-supported lifestyle intervention for pregnant women with an elevated body mass index. Int J Obes 44, 999–1010 (2020). https://doi.org/10.1038/s41366-020-0531-9

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