Original ResearchThe cost-effectiveness of weight management programmes in a postnatal population
Introduction
The proportion of the population in England and Wales who are overweight or obese is increasing.1, 2 This has led to an increase in the prevalence of weight related diseases which in turn are associated with an increase in morbidity, mortality and the costs incurred by health services in treating and managing them. During pregnancy an increase in weight is recommended so that women can remain healthy and satisfy the increased energy demands of gestation. The American Institute of Medicine has issued guidelines for the recommended gestational weight gain based on prepregnancy body mass index (BMI) and are detailed in Table 1.3
However the period following childbirth is one of the most vulnerable for the development of lifestyles that may lead to excessive weight gain.4 The most effective time for women to lose excess weight gained during pregnancy is the six month postnatal period.5
A mathematical model was constructed on behalf of the National Institute for Health and Care Excellence (NICE) to estimate the cost-effectiveness associated with the implementation of a hypothetical public health programme designed to encourage women to lose the excess weight gained during pregnancy in the six month postnatal period.6 The results of the modelling process were used to inform the development of UK public health guidance issued by NICE.7
Section snippets
Methods
A systematic literature search of electronic databases for papers published between 1990 and 2009 relating to weight management interventions which encourage women to return to their prepregnancy weight in the six month postnatal period through physical exercise, dietary management or both was conducted in August 2009 and returned 4414 references. The titles, abstracts and finally the full papers of these identified references were assessed against inclusion and exclusion criteria until five
Results
The deterministic and stochastic (PSA) results are presented in Table 5. Both sets of results indicate that at a threshold of £20,000 per QALY the weight management programme is cost-effective. A jack knife methodology as described in Ref. 22 was used to calculate the mean and the associated 95% confidence intervals around each stochastic result.
Discussion
This work evaluated the costs incurred and QALYs accrued from the implementation of a weight management programme combining a supervised aerobic exercise programme and a healthy calorie controlled diet to a postnatal population in the United Kingdom. This is the first modelling study to examine the potential economic impact of such an intervention and this work has been presented as a foundation for future research.
The ICER of £7355 (£6766–£7945) is significantly below the willingness to pay
Author statements
The views expressed in this manuscript are those of the authors and do not necessarily reflect those of the Centre for Public Health Excellence as part of the National Institute for Health and Care Excellence in the United Kingdom.
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Cited by (4)
Irresponsible and responsible resource management in obstetrics
2017, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Consultation and surveillance after pregnancy similarly decreases costs and risks: the American diabetes prevention trial supports a balanced diet and an active lifestyle after GDM [71]. In the UK, a mean ICER of £7355 was evaluated for weight management programs in obese mothers [72]. A 10% increase in treated early HD after PE would prevent 14,000 deaths [73].