Cost-effectiveness of a mobile health-supported lifestyle intervention for pregnant women with an elevated body mass index
Cost-effectiveness of a mobile health-supported lifestyle intervention for pregnant women with an elevated body mass index
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DOI：
10.1038/s41366-020-0531-9
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发表时间：
2020-01-21
影响因子：
4.9
通讯作者：
McAuliffe, Fionnuala M.
中科院分区：
文献类型：
--
作者：
O'Sullivan, Elizabeth J.;Rokicki, Slawa;McAuliffe, Fionnuala M.
目的评价移动健康支持生活方式干预与常规护理的成本-效果。方法从公费医疗体系的角度进行成本-效果分析。我们估计了从第一次产前保健预约到分娩期间与干预和卫生保健利用相关的成本。我们使用自举方法来量化成本效益估算的不确定性。本分析评估的健康结果包括妊娠期体重增加（GWG; kg）、妊娠期体重超标的发生率、质量调整生命年（QALYs）和大胎龄（LGA）的发生率。增量成本-效果比（ICERs）计算为获得的每质量质量成本、避免的每公斤GWG成本、避免的每例过量GWG成本和避免的每例LGA成本。结果干预组和对照组的总平均成本分别为3745欧元和3471欧元（平均差值为274欧元，P = 0.08）。ICER为每获得QALY 2914欧元。假设上限比率为45000欧元，则基于QALYs的干预措施具有成本效益的概率为79%。避免每公斤GWG的成本为209欧元。避免每公斤GWG的成本效益可接受曲线（CEAC）在905欧元时达到95%的置信水平，表明如果人们愿意为每公斤避免的GWG最多额外支付905欧元，则干预措施具有成本效益的概率为95%。避免过度GWG和避免LGA的成本分别为2117欧元和5911欧元。避免过度GWG的CEAC和避免LGA的CEAC分别达到了95%的置信水平7090欧元和25737欧元。结果表明，移动健康生活方式干预可能具有成本效益；然而，为了确认结果，有必要更好地了解LGA和过度GWG的短期和长期成本。
Objective To assess the cost-effectiveness of a mobile health-supported lifestyle intervention compared with usual care. Methods We conducted a cost-effectiveness analysis from the perspective of the publicly-funded health care system. We estimated costs associated with the intervention and health care utilisation from first antenatal care appointment through delivery. We used bootstrap methods to quantify the uncertainty around cost-effectiveness estimates. Health outcomes assessed in this analysis were gestational weight gain (GWG; kg), incidence of excessive GWG, quality-adjusted life years (QALYs), and incidence of large-for-gestational-age (LGA). Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained, cost per kg of GWG avoided, cost per case of excessive GWG averted, and cost per case of LGA averted. Results Total mean cost including intervention and health care utilisation was euro3745 in the intervention group and euro3471 in the control group (mean difference euro274, P = 0.08). The ICER was euro2914 per QALY gained. Assuming a ceiling ratio of euro45,000, the probability that the intervention was cost-effective based on QALYs was 79%. Cost per kg of GWG avoided was euro209. The cost-effectiveness acceptability curve (CEAC) for kg of GWG avoided reached a confidence level of 95% at euro905, indicating that if one is willing to pay a maximum of an additional euro905 per kg of GWG avoided, there is a 95% probability that the intervention is cost-effective. Costs per case of excessive GWG averted and case of LGA averted were euro2117 and euro5911, respectively. The CEAC for case of excessive GWG averted and for case of LGA averted reached a confidence level of 95% at euro7090 and euro25,737, respectively. Conclusions Results suggest that a mobile-health lifestyle intervention could be cost-effective; however, a better understanding of the short- and long-term costs of LGA and excessive GWG is necessary to confirm the results.