Cost-effectiveness of a mobile health-supported lifestyle intervention for pregnant women with an elevated body mass index

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.