Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil

Abstract

CONTEXT AND OBJECTIVE: Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. METHODS: Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. RESULTS: Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. CONCLUSION: Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.

Diagnostic protocol for gestational diabetes mellitus (GDM) (IADPSG/ADA, 2011): influence on the occurrence of GDM and mild gestational hyperglycemia (MGH) and on the perinatal outcomes

“…Previous results from our research group, show that the cost-effective ratio of maternal and neonatal diagnosis and treatment for prior DM, GDM and MGH is always positive, with social profitability ratio ranging from 1.87 to 5.35 [22]. The treatment protocol was the same for both periods and the 75-g OGTT evaluates two, rather than three, post glucose load plasma glucose levels.…”

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

“…125,130,131,133 Two did not report a cost for an intervention. 101,126 Data on the cost of the intervention were thus extracted for five studies 68,127-129,132 and the median value was used to estimate the cost of the intervention in the model ( Table 24).…”

Effect of ambulatory versus hospital treatment for gestational diabetes or hyperglycemia on infant mortality rates: a systematic review

“…Three studies were excluded from this review: two studies [12][13][14][15][16][17][18][19][20][21] were classified as comparative case series; and one study 22 was…”

“…13 However, the total costs of prenatal, delivery and postpartum care were significantly higher in the diabetic pregnant hospitalization group than in the ambulatory management group. 14 To the best of our knowledge, no systematic review comparing ambulatory management versus hospitalization in GDM or hyperglycemia cases has been conducted.…”