The economic costs and consequences of providing antenatal lifestyle advice for women who are overweight or obese: The LIMIT randomised trial

Abstract

Maternal obesity has been associated with adverse pregnancy and birth outcomes. The objective of this study to estimate the overall cost-effectiveness and to evaluate the impact of antenatal dietary and lifestyle interventions on self-perceived quality of life (QoL) among overweight and obese pregnant women. The study uses data from a multicentre randomized trial conducted in three maternity hospitals in South Australia. 2212 participants of this trial are women with singleton pregnancy, between 10-20 weeks’ gestation and BMI≥25. 1108 women were randomized to a comprehensive dietary and lifestyle interventions delivered by research staff; 1104 were randomized to standard care and received pregnancy care according to local guidelines. The direct out-patient, in-patient and intervention cost till 4 weeks after birth of the baby were obtained, using hospital perspective. Cost effectiveness analysis was done using two significant clinical outcomes of the trial: infants born to women after lifestyle advice group were significantly less likely to have birth weight above 4kg and less likely to suffer from moderate to severe respiratory distress syndrome (RDS) compare to standard care women group. The SF-36 QoL was completed by participants of the trial at randomization, 28- and 36 weeks of gestation and 4 months post partum. The present study shows that there is no significant cost difference between overweight/obese women with special life advice compare with standard care during pregnancy. However, cost effectiveness acceptability curve (CEAC) illustrates that if decision makers take $20,000 as a threshold value for the maximum amount willing to pay, then the probability of being cost effective to have infant over 4kg would be 0.85 for lifestyle group compare with 0.15 for standard care group. Similarly, with same threshold values, the probability of being cost effective to avoid another case of infant suffer from moderate to severe lung infection would be 0.64 for lifestyle group compare with 0.37 for standard care group. In terms of changes in QoL, the combined treatment and time effects were not significantly different between two groups.