A cost effectiveness evaluation of a dietitian-delivered telephone coaching program during pregnancy for preventing gestational diabetes mellitus

Abstract

Background: The aim of this study was to calculate the cost-effectiveness of a telehealth coaching intervention to reduce GDM and to calculate the breakeven point of reducing GDM. Methods: Data to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 3,578 pregnant people (mean age 30.9 + 5.3 years, 18.8% BMI 25-29.9, 18.6% BMI >30kg/m2; 67.4% multiparous) were included in the analyses. Results: The cost of providing routine care and routine care plus LWdP intervention to pregnant women was calculated to be AUD 22,827 and AUD 22,537, respectively. The effectiveness of LWdP program (0.894 utility) is slightly higher compared to routine care (0.893). Therefore, the value of ICER is negative and it indicates that the LWdP program is a dominant strategy to reduce GDM in pregnant women. We also performed probabilistic sensitivity analysis using Monte Carlo simulation over 1,000 simulations. The ICE scatter plot showed that LWdP intervention is dominant over routine care in 99.60% of the trials using a willingness to pay threshold of AUD 50,000. Conclusions: Findings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system.