- Title
- Economic analysis of maternal health behaviours
- Creator
- Szewczyk, Zoe Aleksandra
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background and aims: Identifying, measuring and valuing the economic impact of antenatal guidelines and their implementation has been identified as a key strategy for informing investment in health promotion and improving efficiency in healthcare. The research question of this thesis was: what is the economic impact of improving the modifiable maternal health risk behaviours, alcohol and dietary intake, on health care resource use during the antenatal period? To address this question, the thesis aims were: 1. Identify and synthesize evidence regarding the costs and impacts of antenatal nutrition and alcohol interventions and their associated implementation strategies. 2. Assess the cost, cost-consequence and cost-effectiveness of a multi-strategy practice change intervention in increasing antenatal care addressing the consumption of alcohol by pregnant women. 3. Assess the economic impact of maternal diet quality and weight status of pregnant women and their impact on resource use in the delivery period. Methods: To address the first objective, a systematic review of economic evaluations of antenatal nutrition and alcohol interventions and their associated implementation strategies was conducted. For the second objective, an economic evaluation was undertaken alongside a randomised controlled trial (RCT) of a multi-strategy practice change intervention designed to support antenatal care staff in providing a model of care consistent with clinical guideline recommendations for alcohol consumption in pregnancy. For the third objective, an observational study was conducted to gather self-report data and inpatient medical records for N=670 pregnant women in Newcastle, Australia, to examine the economic impact of maternal diet quality on resource use in the antenatal period. Results: The systematic review identified a paucity of economic evidence regarding antenatal nutrition and alcohol interventions and no economic evaluations of associated implementation strategies. The trial-based economic analysis determined the practice change intervention to be both more effective and more costly than usual care. The average incremental cost per eligible clinician was $993 (range: $640-$1928) and $591 (range: $329 - $940) per woman who received all guideline elements. The observational study found higher body mass index (BMI) was associated with increased odds of caesarean delivery; women in obese class II (35.0–39.9 kg/m2) had significantly higher odds of caesarean delivery compared to women of normal weight (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). The average cost per patient increased with BMI, being $7962, $9309 and $9914 for women in the normal, obese class II and obese class III weight categories. Higher diet quality was associated with a small statistically significant reduction in maternal length of stay. Conclusion: The research included in this thesis addressed a small and significant gap in the evidence base necessary to inform greater understanding of the cost and cost-effectiveness of current nutrition and alcohol recommendations in pregnancy. The thesis provides new evidence regarding the economic impact of maternal health behaviours and antenatal health promotion interventions. Specifically, the economic evidence available to inform investment in future maternal alcohol and nutrition interventions was mapped, synthesized, and the gaps in the literature identified. The trial-based economic evaluation was the first to identify, measure, and value investment in antenatal guideline implementation efforts. Whilst healthcare funders’ willingness to pay for the incremental effect of this intervention is unknown, the strategic investment in systems change is expected to improve the efficiency of the practice change intervention over time. The observational study identified that poor dietary patterns are common during pregnancy; thus, interventions to improve maternal BMI and diet quality could deliver substantive economic benefits to the healthcare system and community. The evidence presented in this thesis addresses the need for decision makers to be cognisant of the resource use implications of policy implementation.
- Subject
- health economics; economic evaluation; implementation science; nutrition; diet; maternal and infant; antenatal; cost; pregnancy; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1440224
- Identifier
- uon:41106
- Rights
- Copyright 2022 Zoe Aleksandra Szewczyk
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 9 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 192 KB | Adobe Acrobat PDF | View Details Download |