孕期生活方式干预的成本效益比较。
A Comparison of the Cost-Effectiveness of Lifestyle Interventions in Pregnancy.
机构信息
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Warwick Business School, Warwick University, Coventry, England, UK.
出版信息
Value Health. 2022 Feb;25(2):194-202. doi: 10.1016/j.jval.2021.07.013. Epub 2021 Sep 20.
OBJECTIVES
Lifestyle interventions during pregnancy improve maternal and infant outcomes. We aimed to compare the cost-effectiveness of 4 antenatal lifestyle intervention types with standard care.
METHODS
A decision tree model was constructed to compare lifestyle intervention effects from a novel meta-analysis. The target population was women with singleton pregnancies and births at more than 20 weeks' gestation. Interventions were categorized as diet, diet with physical activity, physical activity, and mixed (lacking structured diet and, or, physical activity components). The outcome of interest was cost per case prevented (gestational diabetes, hypertensive disorders in pregnancy, cesarean birth) expressed as an incremental cost-effectiveness ratio (ICER) from the Australian public healthcare perspective. Scenario analyses were included for all structured interventions combined and by adding neonatal intensive care unit costs. Costs were estimated from published data and consultations with experts and updated to 2019 values. Discounting was not applied owing to the short time horizon.
RESULTS
Physical activity interventions reduced adverse maternal events by 4.2% in the intervention group compared with standard care and could be cost saving. Diet and diet with physical activity interventions reduced events by 3.5% (ICER = A$4882) and 2.9% (ICER = A$2020), respectively. Mixed interventions did not reduce events and were dominated by standard care. In scenario analysis, all structured interventions combined and all interventions when including neonatal intensive care unit costs (except mixed) may be cost saving. Probabilistic sensitivity analysis showed that for physical activity and all structured interventions combined, the probability of being cost saving was 58% and 41%, respectively.
CONCLUSIONS
Governments can expect a good return on investment and cost savings when implementing effective lifestyle interventions population-wide.
目的
孕期生活方式干预可改善母婴结局。本研究旨在比较 4 种产前生活方式干预与标准护理的成本效益。
方法
构建决策树模型，比较来自新荟萃分析的生活方式干预效果。目标人群为单胎妊娠且孕 20 周以上分娩的女性。干预措施分为饮食、饮食加运动、运动和混合（缺乏结构化饮食和/或运动成分）。感兴趣的结局为每例预防病例的成本（妊娠期糖尿病、妊娠高血压疾病、剖宫产），以澳大利亚公共医疗保健视角下的增量成本效益比（ICER）表示。纳入所有结构化干预综合分析和添加新生儿重症监护病房（NICU）成本的情景分析。成本根据已发表数据和专家咨询进行估算，并更新至 2019 年。由于时间短，不进行贴现。
结果
与标准护理相比，运动干预可使不良母婴结局减少 4.2%，且可能具有成本效益。饮食和饮食加运动干预可使不良事件分别减少 3.5%（ICER=A$4882）和 2.9%（ICER=A$2020）。混合干预未能减少不良事件，且被标准护理所主导。在情景分析中，所有结构化干预综合分析和所有干预措施（NICU 成本除外）可能具有成本效益。概率敏感性分析显示，运动和所有结构化干预综合分析的成本效益比为 58%和 41%，具有成本效益的概率分别为 58%和 41%。
结论
政府在全人群中实施有效的生活方式干预可获得良好的投资回报和成本节约。
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