肥胖孕妇的生活方式控制干预的成本效益。
Cost effectiveness of a controlled lifestyle intervention for pregnant women with obesity.
机构信息
Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden.
Centre for Person-Centred Care - GPCC, University of Gothenburg, Gothenburg, Sweden.
出版信息
BMC Pregnancy Childbirth. 2021 Sep 21;21(1):639. doi: 10.1186/s12884-021-04098-5.
BACKGROUND
The Mighty Mums antenatal lifestyle intervention is a person-centered behavioral intervention focusing on nutrition and physical activity for pregnant women with obesity (body mass index [BMI] ≥30). The aim of this study was to evaluate the costs and clinical outcomes of adding the Mighty Mums intervention to standard antenatal care.
METHODS
Participants in the intervention group (n = 434) received motivational talks with their midwife and a selection of physical and/or nutritional activities in addition to antenatal care. Control participants (n = 867) from adjacent geographic areas received standard antenatal care. Costs for staff, unit costs for specific activities, and registered costs for specialized antenatal care were analyzed for associations with gestational weight gain and self-reported health. Results are reported for the intention-to-treat (ITT) population and a per protocol (PP) population identified by participation in the intervention. Analyses included bootstrapped linear regressions adjusted for background characteristics that differed significantly between groups.
RESULTS
The average costs were SEK 9727 higher (95% confidence interval [CI]: 6677 to 12,777) among participants in the intervention group than in the control ITT population and SEK 8655 (95% CI 4586 to 12,724) higher than in the PP population. The cost increase per 1 kg reduction in gestational weight gain was SEK 12,369 in the ITT population and SEK 7209 for the PP population.
CONCLUSION
Participation in the Mighty Mums intervention was associated with higher costs, but also reduced gestational weight gain. The cost per kilogram reduction in gestational weight gain was low, particularly in the PP population. A future decision to implement this behavioral intervention in standard care should take into account society's willingness to pay per unit reduction in gestational weight gain.
TRIAL REGISTRATION
The study is registered at ClinicalTrials.gov , Identifier: NCT03147079 .
背景
强大妈妈产前生活方式干预是一种以人为中心的行为干预，专注于肥胖孕妇的营养和身体活动（体重指数[BMI]≥30）。本研究旨在评估在标准产前护理中添加强大妈妈干预措施的成本和临床结果。
方法
干预组（n=434）的参与者除了接受产前护理外，还接受了与他们的助产士的动机谈话以及一系列身体和/或营养活动。来自相邻地理区域的对照组（n=867）接受标准产前护理。对与妊娠体重增加和自我报告的健康相关的员工成本、特定活动的单位成本以及专门产前护理的注册成本进行了分析。结果报告了意向治疗（ITT）人群和通过参与干预确定的符合方案（PP）人群。分析包括调整了组间差异显著的背景特征的 bootstrap 线性回归。
结果
与 ITT 人群相比，干预组的参与者的平均成本高出 9727 瑞典克朗（95%置信区间[CI]：6677 至 12777），与 PP 人群相比，高出 8655 瑞典克朗（95%CI：4586 至 12724）。在 ITT 人群中，每减少 1 公斤妊娠体重增加的成本增加了 12369 瑞典克朗，在 PP 人群中，成本增加了 7209 瑞典克朗。
结论
参与强大妈妈干预与更高的成本相关，但也与减少妊娠体重增加相关。每公斤妊娠体重增加减少的成本较低，尤其是在 PP 人群中。未来在标准护理中实施这种行为干预的决策应考虑社会对每单位妊娠体重增加减少的支付意愿。
试验注册
该研究在 ClinicalTrials.gov 注册，标识符：NCT03147079。
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