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Randomized Controlled Trial
. 2013;8(2):e56392.
doi: 10.1371/journal.pone.0056392. Epub 2013 Feb 15.

Cost-effectiveness of lifestyle counselling as primary prevention of gestational diabetes mellitus: findings from a cluster-randomised trial

Päivi Kolu  1 , Jani Raitanen, Pekka Rissanen, Riitta Luoto
Affiliations
Randomized Controlled Trial

Cost-effectiveness of lifestyle counselling as primary prevention of gestational diabetes mellitus: findings from a cluster-randomised trial

Päivi Kolu et al. PLoS One. 2013.

Abstract

Aims: The aim was to evaluate the cost-effectiveness of primary prevention of gestational diabetes mellitus (GDM) through intensified counselling on physical activity, diet, and appropriate weight gain among the risk group.

Materials and methods: The cost-effectiveness analysis was based on data from a cluster-randomised controlled GDM prevention trial carried out in primary health-care maternity clinics in Finland. Women (n = 399) with at least one risk factor for GDM were included. The incremental cost-effectiveness ratio (ICER) was calculated in terms of birth weight, 15D, and perceived health as measured with a visual analogue scale (VAS). A bootstrap technique for cluster-randomised samples was used to estimate uncertainty around a cost-effectiveness acceptability curve.

Results: The mean total cost in the intervention group was €7,763 (standard deviation (SD): €4,511) and in the usual-care group was €6,994 (SD: €4,326, p = 0.14). The mean intervention cost was €141. The difference for costs in the birth-weight group was €753 (95% CI: -250 to 1,818) and in effects for birth weight was 115 g (95% CI: 15 to 222). The ICER for birth weight was almost €7, with 86.7% of bootstrap pairs located in the north-east quadrant, indicating that the intervention was more effective and more expensive in birth weight terms than the usual care was. The data show an 86.7% probability that each gram of birth weight avoided requires an additional cost of €7.

Conclusions: Intervention was effective for birth weight but was not cost-effective for birth weight, 15D, or VAS when compared to the usual care.

Trial registration: ISRCTN 33885819.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Cost-effectiveness plane (upper) and acceptability curve (lower) for birth weight.
Figure 2
Figure 2. Cost-effectiveness plane (upper) and acceptability curve (lower) for 15D.
Figure 3
Figure 3. Cost-effectiveness plane (upper) and acceptability curve (lower) for perceived health (VAS).
See this image and copyright information in PMC

References

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