Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia – a pilot evaluation

Abstract

Background: Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life.Objective: Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data.Results: The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences.Conclusion: Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the urgent need to collect more country-specific data on the incidence of macrosomic births and health outcomes. In addition, it would be of interest to further explore the long-term health economic consequences of macrosomia and related risk factors.

Economic burden of maternal morbidity – A systematic review of cost-of-illness studies

“…There was also a lack of sensitivity analysis exploring the impact of uncertainty relating to the prevalence of particular health problems, treatment rates, and unit prices, with only 12 studies (3%) reporting some form of sensitivity analysis, and one reporting having used conservative estimates to mitigate parameter uncertainty. [20,21,[25][26][27][28][29][30][31][32][33][34][35]…”

FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long‐term Maternal Implications of Pregnancy Complications—Follow‐up Considerations

“…Estimation of the direct health economic burden of maternal overweight, GDM, and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of the budgetary impact of GDM, based on a conservative approach, using the USA costing data in the model, indicates an annual cost of more than US $1.8 billion without considering the long‐term consequences …”

“…Given that lifestyle interventions or use of medications for prevention of diabetes in people at risk in various settings are regarded as highly cost‐effective, and that treatment of GDM is cost‐effective in preventing perinatal complications, it seems intuitive that screening and comprehensive care for GDM should be highly cost‐effective overall …”

“…The calculation of the budgetary impact of GDM, based on a conservative approach, using the USA costing data in the model, indicates an annual cost of more than US $1.8 billion without considering the long-term consequences. 199 A recent US study reported that each case of GDM was associated with US $5800 in higher medical expenditures. GDM only slightly raised medical costs for newborns (average US $40/newborn) but substantially raised the mother's costs related to the pregnancy and birth (average US $5760/mother).…”

Tackling maternal obesity: Building an evidence base to reflect the complexity of lifestyle behaviour change

“…Obesity in pregnancy is placing a considerable burden on healthcare services and resources (Morgan et al, 2015). Data from a health economic framework developed using US costing data to provide an insight into the short-term health economic impacts of maternal overweight, gestational diabetes mellitus (GDM) and fetal macrosomia identified annual healthcare costs of more than $1.8 billion, without taking any longer-term consequences into account (Lenoir-Wijnkoop et al 2015).…”