Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, USA.
Value Health. 2022 Dec;25(12):2062-2080. doi: 10.1016/j.jval.2022.07.014. Epub 2022 Aug 18.
This study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research.
Electronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list.
Among the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP.
Existing economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.
本研究旨在总结关于管理妊娠期糖尿病和妊娠高血压疾病（HDP）的产前和产后干预的经济结果的证据，评估每项研究的质量，并确定可能为未来研究提供信息的研究空白。
从 2000 年 1 月 1 日到 2021 年 10 月 1 日，检索了电子数据库，包括 PubMed/MEDLINE、Embase、Cochrane 图书馆和 Cochrane 对照试验中心注册库。对选定的研究进行叙述性综合，并以叙述和表格形式呈现提取的数据。使用健康经济评估报告标准的一致性和健康经济标准清单评估每项研究的质量。
通过系统评价确定的 22 项研究中，有 19 项报告了干预措施具有有利的成本效益。对于 HDP 的产前管理，与面对面就诊相比，家庭血压监测在改善母婴结局方面具有成本效益。对于产后护理，对于有妊娠期糖尿病或 HDP 病史的女性，定期筛查高血压或代谢综合征并随后进行治疗被发现具有成本效益，而不进行筛查则没有成本效益。
现有的经济评估研究表明，产前家庭血压监测和产后高血压或代谢综合征筛查具有成本效益。然而，当前经济评估方法的局限性可能会降低证据的质量，需要进一步调查。
