title: The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial.
abstract: BACKGROUND
  Overweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10(+0)-20(+0) weeks, and BMI ≥25 kg/m(2) were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Analyses utilised intention to treat principles.
  
  
  RESULTS
  Overall, the increase in mean costs associated with providing the intervention was offset by savings associated with improved immediate neonatal outcomes, rendering the intervention cost neutral (Lifestyle Advice Group $11261.19±$14573.97 versus Standard Care Group $11306.70±$14562.02; p=0.094). Using a monetary value of $20,000 as a threshold value for avoiding an additional infant with birth weight above 4 kg, the probability that the antenatal intervention is cost-effective is 0.85, which increases to 0.95 when the threshold monetary value increases to $45,000.
  
  
  CONCLUSIONS
  Providing an antenatal dietary and lifestyle intervention for pregnant women who are overweight or obese is not associated with increased costs or cost savings, but is associated with a high probability of cost effectiveness. Ongoing participant follow-up into childhood is required to determine the medium to long-term impact of the observed, short-term endpoints, to more accurately estimate the value of the intervention on risk of obesity, and associated costs and health outcomes.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).
authors.affiliation: School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
authors.forename: Jodie M
authors.initials: JM
authors.lastname: Dodd
authors.affiliation: Agricultural and Food Economics, Global Food Studies, Faculty of the Professions, The University of Adelaide, Adelaide, Australia ; Women's and Children's Health Research Institute, North Adelaide, Australia.
authors.forename: Sharmina
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: School of Population Health, The University of Adelaide, Adelaide, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karnon
authors.affiliation: Agricultural and Food Economics, Global Food Studies, Faculty of the Professions, The University of Adelaide, Adelaide, Australia ; Women's and Children's Health Research Institute, North Adelaide, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Umberger
authors.affiliation: School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Deussen
authors.affiliation: School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
authors.forename: Thach
authors.initials: T
authors.lastname: Tran
authors.affiliation: School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
authors.forename: Rosalie M
authors.initials: RM
authors.lastname: Grivell
authors.affiliation: School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Crowther
authors.affiliation: School of Psychology, The University of Adelaide, Adelaide, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Turnbull
authors.affiliation: Department of Neonatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: McPhee
authors.affiliation: School of Medicine, The University of Adelaide, Adelaide, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Wittert
authors.affiliation: School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Owens
authors.affiliation: School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Robinson
keywords: Cost effectiveness analysis; Health economics evaluation; Overweight and obesity; Pregnancy; Randomised trial; dietary and lifestyle intervention