Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Monash Centre for Health Research and Implementation, Monash University, Level 1 42-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
Curr Diab Rep. 2020 Feb 1;20(2):6. doi: 10.1007/s11892-020-1288-1.
Lifestyle interventions (such as diet and physical activity) successfully limit excessive gestational weight gain and can reduce some adverse maternal events; however, benefit is variable and cost-effectiveness remains unclear. We aimed to review published cost-effectiveness analyses of lifestyle interventions compared with usual care on clinically relevant outcome measures. Five international and six grey-literature databases were searched from 2007 to 2018. Articles were assessed for quality of reporting. Data were extracted from healthcare and societal perspectives. Costs were adapted to the common currencies of Australia and the United Kingdom by adjusting for resource utilization, healthcare purchase price and changes in costs over time. Included studies were economic analyses of lifestyle interventions aiming to limit weight-gain during pregnancy and/or reduce risk of gestational diabetes, for women with a BMI of 25 or greater in pre- or early-pregnancy.
Of the 538 articles identified, six were retained for review: one modelling study and five studies in which an economic analysis was performed alongside a randomized-controlled trial. Outcome measures included infant birth-weight, fasting glucose, insulin resistance, gestational weight-gain, infant respiratory distress syndrome, perceived health, cost per case of adverse outcome avoided and quality-adjusted life years (QALYs). Interventions were cost-effective in only one study. Although many studies have investigated the efficacy of lifestyle interventions in pregnancy, few have included cost-effectiveness analyses. Where cost-effectiveness studies were undertaken, results were inconsistent. Secondary meta-analysis, taxonomy and framework research is now required to determine the effective components of lifestyle interventions and to guide future cost-effectiveness analyses.
综述目的：生活方式干预（如饮食和身体活动）可成功限制孕期体重过度增加，并可减少一些不良的母婴结局；然而，其益处具有变异性，成本效益仍不清楚。我们旨在综述已发表的关于生活方式干预与常规护理在临床相关结局方面的成本效益分析。从 2007 年至 2018 年，我们检索了五个国际和六个灰色文献数据库。评估了报告质量的文章。从医疗保健和社会角度提取数据。通过调整资源利用、医疗保健购买价格和成本随时间的变化，将成本转换为澳大利亚和英国的常见货币。纳入的研究是针对孕期体重增加限制和/或降低妊娠糖尿病风险的生活方式干预的经济分析，研究对象为孕期或孕早期 BMI 为 25 或以上的女性。
最新发现：在 538 篇文章中，有 6 篇被保留进行综述：一项建模研究和五项经济分析与随机对照试验同时进行的研究。结局指标包括婴儿出生体重、空腹血糖、胰岛素抵抗、孕期体重增加、婴儿呼吸窘迫综合征、感知健康、避免不良结局的每例成本和质量调整生命年（QALYs）。仅在一项研究中，干预措施具有成本效益。尽管许多研究都调查了孕期生活方式干预的效果，但很少有包括成本效益分析的研究。在进行了成本效益研究的情况下，结果并不一致。现在需要进行二次荟萃分析、分类学和框架研究，以确定生活方式干预的有效成分，并指导未来的成本效益分析。
