IDEAS home Printed from
   My bibliography  Save this article

Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy


  • Cate Bailey

    (Monash University)

  • Helen Skouteris

    (Monash University)

  • Cheryce L. Harrison

    (Monash University)

  • Jacqueline Boyle

    (Monash University)

  • Rebeccah Bartlett

    (Monash University)

  • Briony Hill

    (Monash University)

  • Shakila Thangaratinam

    (Queen Mary University of London)

  • Helena Teede

    (Monash University)

  • Zanfina Ademi

    (Monash University)


Background Lifestyle interventions (diet, physical activity and/or behavioural) to optimise gestational weight gain can prevent adverse maternal outcomes such as gestational diabetes, pre-eclampsia and caesarean section. Objective We aimed to model the cost effectiveness of lifestyle interventions during pregnancy on reducing adverse maternal outcomes. Methods Decision tree modelling was used to determine the cost effectiveness of lifestyle interventions compared with usual care on preventing cases of gestational diabetes and hypertensive disease in pregnancy. Participants were pregnant women receiving routine antenatal care in secondary and tertiary care hospitals. The main outcome measures were cases of gestational diabetes and/or hypertensive disease in pregnancy prevented, costs, and incremental cost-effectiveness ratios. Analysis was conducted from the perspective of the Australian healthcare system, with a time horizon of early pregnancy to discharge after birth. Results Women in the intervention group were 2.25% less likely to have gestational diabetes and/or hypertensive disease in pregnancy (9.53%) compared with the control group (11.78%). Intervention costs were Australian dollars (AUD) 228 per person. Costs were AUD33 per person higher in the intervention group (AUD8281) than the control group (AUD8248). The incremental cost-effectiveness ratio was AUD1470 per case prevented. Sensitivity analysis showed that base-case results were robust. In the probabilistic sensitivity analysis, 44.8% of data points fell within the north-east quadrant, and 52.2% in the south-east quadrant (cost saving), with a 95% confidence interval ranging from AUD − 50,018 to 32,779 per case prevented. Conclusions While there is no formally accepted cost-effectiveness threshold for willingness-to-pay to prevent an adverse maternal event, the cost per person receiving a lifestyle intervention compared with controls was close to neutral, and therefore likely to be cost effective. Exploration of the cost effectiveness of different lifestyle delivery modes across various models of antenatal care is now required. Future cost-effectiveness studies should investigate longer time horizons, quality-adjusted life-years and productivity loss. Trial Registration Not applicable.

Suggested Citation

  • Cate Bailey & Helen Skouteris & Cheryce L. Harrison & Jacqueline Boyle & Rebeccah Bartlett & Briony Hill & Shakila Thangaratinam & Helena Teede & Zanfina Ademi, 2020. "Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy," PharmacoEconomics - Open, Springer, vol. 4(3), pages 499-510, September.
  • Handle: RePEc:spr:pharmo:v:4:y:2020:i:3:d:10.1007_s41669-020-00197-9
    DOI: 10.1007/s41669-020-00197-9

    Download full text from publisher

    File URL:
    File Function: Abstract
    Download Restriction: no

    File URL:
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Rita Faria’s journal round-up for 14th September 2020
      by Rita Faria in The Academic Health Economists' Blog on 2020-09-14 11:00:07

    More about this item


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharmo:v:4:y:2020:i:3:d:10.1007_s41669-020-00197-9. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.