Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review

• Published in: Value in health Vol. 25; no. 12; pp. 2062 - 2080
• Main Authors: Li, Weixin, Kim, Chi-Son, Howell, Elizabeth A., Janevic, Teresa, Liu, Bian, Shi, Lizheng, Li, Yan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2022
• Subjects: cardiometabolic risks; Cost-Benefit Analysis; cost-effectiveness; Diabetes, Gestational - prevention & control; Diabetes, Gestational - therapy; economic evaluation; Female; gestational diabetes mellitus; Humans; Hypertension, Pregnancy-Induced - diagnosis; Hypertension, Pregnancy-Induced - therapy; hypertensive disorder of pregnancy; Infant, Newborn; maternal health; Metabolic Syndrome; Postnatal Care; Pregnancy; cost-effectiveness; maternal health; economic evaluation; gestational diabetes mellitus; cardiometabolic risks; hypertensive disorder of pregnancy
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2022.07.014

This study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research. Electronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list. Among the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP. Existing economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation. •Existing systematic reviews have confirmed the clinical effectiveness of many prenatal and postpartum interventions among women with gestational diabetes or hypertensive disorders of pregnancy.•This study adds to existing knowledge by systematically reviewing economic evaluations of prenatal and postpartum interventions among women with gestational diabetes or hypertensive disorders of pregnancy.•More high-quality economic evaluations of prenatal and postpartum interventions are needed to help healthcare decision makers optimize the allocation of limited resources to improve maternal health outcomes and curb increasing healthcare costs nationwide.