title: Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: results of an economic evaluation alongside a randomised controlled trial.
abstract: BACKGROUND
  The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM and the risks associated with GDM lead to increased health care costs and losses in productivity. The objective of this study is to evaluate whether the FitFor2 exercise program during pregnancy is cost-effective from a societal perspective as compared to standard care.
  
  
  METHODS
  A randomised controlled trial (RCT) and simultaneous economic evaluation of the FitFor2 program were conducted. Pregnant women at risk for GDM were randomised to an exercise program to prevent high maternal blood glucose (n = 62) or to standard care (n = 59). The exercise program consisted of two sessions of aerobic and strengthening exercises per week. Clinical outcome measures were maternal fasting blood glucose levels, insulin sensitivity and infant birth weight. Quality of life was measured using the EuroQol 5-D and quality-adjusted life-years (QALYs) were calculated. Resource utilization and sick leave data were collected by questionnaires. Data were analysed according to the intention-to-treat principle. Missing data were imputed using multiple imputations. Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios.
  
  
  RESULTS
  There were no statistically significant differences in any outcome measure. During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204). The cost-effectiveness analyses showed that the exercise program was not cost-effective in comparison to the control group for blood glucose levels, insulin sensitivity, infant birth weight or QALYs.
  
  
  CONCLUSIONS
  The twice-weekly exercise program for pregnant women at risk for GDM evaluated in the present study was not cost-effective compared to standard care. Based on these results, implementation of this exercise program for the prevention of GDM cannot be recommended.
  
  
  BACKGROUND
  NTR1139.
authors: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Nicolette
authors: N
authors: Oostdam
authors: Judith
authors: J
authors: Bosmans
authors: Maurice G A J
authors: MG
authors: Wouters
authors: Elisabeth M W
authors: EM
authors: Eekhoff
authors: Willem
authors: W
authors: van Mechelen
authors: Mireille N M
authors: MN
authors: van Poppel
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D016640:Diabetes, Gestational / Q000191:economics / Q000517:prevention & control*; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007333:Insulin Resistance; D057194:Intention to Treat Analysis; D009426:Netherlands; D018579:Patient Selection; D011247:Pregnancy; D011788:Quality of Life; D018582:Sick Leave