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

Karen Broekhuizen; David Simmons; Roland Devlieger; André van Assche; Goele Jans; Sander Galjaard; Rosa Corcoy; Juan M. Adelantado; Fidelma Dunne; Gernot Desoye; Jürgen Harreiter; Alexandra Kautzky-Willer; Peter Damm; Elisabeth R. Mathiesen; Dorte M. Jensen; Liselotte L. Andersen; Annunziata Lapolla; Maria G. Dalfra; Alessandra Bertolotto; Ewa Wender-Ozegowska; Agnieszka Zawiejska; David Hill; Frank J. Snoek; Judith G.M. Jelsma; Judith E. Bosmans; Mireille N.M. van Poppel; Johanna M. van Dongen

doi:10.1186/s12966-018-0643-y

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

Karen Broekhuizen, David Simmons, Roland Devlieger, André van Assche, Goele Jans, Sander Galjaard, Rosa Corcoy, Juan M. Adelantado, Fidelma Dunne, Gernot Desoye, Jürgen Harreiter, Alexandra Kautzky-Willer, Peter Damm, Elisabeth R. Mathiesen, Dorte M. Jensen, Liselotte L. Andersen, Annunziata Lapolla, Maria G. Dalfra, Alessandra Bertolotto, Ewa Wender-OzegowskaAgnieszka Zawiejska, David Hill, Frank J. Snoek, Judith G.M. Jelsma, Judith E. Bosmans, Mireille N.M. van Poppel, Johanna M. van Dongen^*

^*Corresponding author for this work

Department of Clinical Medicine

8 Citations (Scopus)

48 Downloads (Pure)

Abstract

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.

Original language	English
Article number	23
Journal	International Journal of Behavioral Nutrition and Physical Activity
Volume	15
Number of pages	12
ISSN	1479-5868
DOIs	https://doi.org/10.1186/s12966-018-0643-y
Publication status	Published - 2018

Keywords

Cost-effectiveness
Economic evaluation
Gestational diabetes
Lifestyle intervention
Pregnant women

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Broekhuizen, K., Simmons, D., Devlieger, R., van Assche, A., Jans, G., Galjaard, S., Corcoy, R., Adelantado, J. M., Dunne, F., Desoye, G., Harreiter, J., Kautzky-Willer, A., Damm, P., Mathiesen, E. R., Jensen, D. M., Andersen, L. L., Lapolla, A., Dalfra, M. G., Bertolotto, A., ... van Dongen, J. M. (2018). 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. International Journal of Behavioral Nutrition and Physical Activity, 15, [23]. https://doi.org/10.1186/s12966-018-0643-y

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. / Broekhuizen, Karen; Simmons, David; Devlieger, Roland et al.

In: International Journal of Behavioral Nutrition and Physical Activity, Vol. 15, 23, 2018.

Research output: Contribution to journal › Journal article › Research › peer-review

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 2018, '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', International Journal of Behavioral Nutrition and Physical Activity, vol. 15, 23. https://doi.org/10.1186/s12966-018-0643-y

Broekhuizen K, Simmons D, Devlieger R, van Assche A, Jans G, Galjaard S et al. 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. International Journal of Behavioral Nutrition and Physical Activity. 2018;15:23. doi: 10.1186/s12966-018-0643-y

Broekhuizen, Karen ; Simmons, David ; Devlieger, Roland et al. / 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. In: International Journal of Behavioral Nutrition and Physical Activity. 2018 ; Vol. 15.

@article{d929a02338564dc38fb0c2fc609400de,

title = "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",

abstract = "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.",

keywords = "Cost-effectiveness, Economic evaluation, Gestational diabetes, Lifestyle intervention, Pregnant women",

author = "Karen Broekhuizen and David Simmons and Roland Devlieger and {van Assche}, Andr{\'e} and Goele Jans and Sander Galjaard and Rosa Corcoy and Adelantado, {Juan M.} and Fidelma Dunne and Gernot Desoye and J{\"u}rgen Harreiter and Alexandra Kautzky-Willer and Peter Damm and Mathiesen, {Elisabeth R.} and Jensen, {Dorte M.} and Andersen, {Liselotte L.} and Annunziata Lapolla and Dalfra, {Maria G.} and Alessandra Bertolotto and Ewa Wender-Ozegowska and Agnieszka Zawiejska and David Hill and Snoek, {Frank J.} and Jelsma, {Judith G.M.} and Bosmans, {Judith E.} and {van Poppel}, {Mireille N.M.} and {van Dongen}, {Johanna M.}",

year = "2018",

doi = "10.1186/s12966-018-0643-y",

language = "English",

volume = "15",

journal = "International Journal of Behavioral Nutrition and Physical Activity",

issn = "1479-5868",

publisher = "BioMed Central",

}

TY - JOUR

T1 - Cost-effectiveness of healthy eating and/or physical activity promotion in pregnant women at increased risk of gestational diabetes mellitus

T2 - Economic evaluation alongside the DALI study, a European multicenter randomized controlled trial

AU - Broekhuizen, Karen

AU - Simmons, David

AU - Devlieger, Roland

AU - van Assche, André

AU - Jans, Goele

AU - Galjaard, Sander

AU - Corcoy, Rosa

AU - Adelantado, Juan M.

AU - Dunne, Fidelma

AU - Desoye, Gernot

AU - Harreiter, Jürgen

AU - Kautzky-Willer, Alexandra

AU - Damm, Peter

AU - Mathiesen, Elisabeth R.

AU - Jensen, Dorte M.

AU - Andersen, Liselotte L.

AU - Lapolla, Annunziata

AU - Dalfra, Maria G.

AU - Bertolotto, Alessandra

AU - Wender-Ozegowska, Ewa

AU - Zawiejska, Agnieszka

AU - Hill, David

AU - Snoek, Frank J.

AU - Jelsma, Judith G.M.

AU - Bosmans, Judith E.

AU - van Poppel, Mireille N.M.

AU - van Dongen, Johanna M.

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

KW - Cost-effectiveness

KW - Economic evaluation

KW - Gestational diabetes

KW - Lifestyle intervention

KW - Pregnant women

U2 - 10.1186/s12966-018-0643-y

DO - 10.1186/s12966-018-0643-y

M3 - Journal article

C2 - 29540227

AN - SCOPUS:85043782071

SN - 1479-5868

VL - 15

JO - International Journal of Behavioral Nutrition and Physical Activity

JF - International Journal of Behavioral Nutrition and Physical Activity

M1 - 23

ER -