This study used a decision-analytic Markov model to estimate the lifetime cost effectiveness of routinely offering a structured lifestyle intervention in early pregnancy, to reduce the risk of gestational diabetes (GDM), for all women undergoing pregnancy in Australia.
The costing for the intervention, which involved structured diet and/or physical activity education, with or without behaviour change, included staff costs and fixed costs, and assumed an average caseload of 500 mothers per coach per year, resulting in cost of AU$228 per pregnancy, or a lifetime cost increase of $70 million compared with usual care.
The model projected a 10% reduction in incident type 2 diabetes among Australian mothers, based on meta-analyses of intervention effectiveness. The cost savings, including reduced costs of antenatal care for GDM, birth complications and long-term type 2 diabetes management, were projected to be $85 million.
The intervention was predicted to be cost-saving compared with usual care, with a return on investment of $1.22 per dollar invested. Cost savings remained when sensitivity analyses were performed, including different lifetime risks of developing type 2 diabetes post-GDM and different healthcare and societal costs of chronic conditions.
The authors conclude that routine implementation of a structured lifestyle intervention during pregnancy would be highly cost-effective from healthcare and societal perspectives.