TY - JOUR
T1 - Economic evaluation of a lifestyle intervention in primary care to prevent type 2 diabetes mellitus and cardiovascular diseases
T2 - a randomized controlled trial
AU - van Wier, Marieke F
AU - Lakerveld, Jeroen
AU - Bot, Sandra D M
AU - Chinapaw, Mai J M
AU - Nijpels, Giel
AU - van Tulder, Maurits W
PY - 2013/4/4
Y1 - 2013/4/4
N2 - BACKGROUND: Cost-effectiveness studies of lifestyle interventions in people at risk for lifestyle-related diseases, addressing 'real-world' implementation, are needed. This study examines the cost-effectiveness of a primary care intervention from a societal perspective, compared with provision of health brochures, alongside a randomized controlled trial.METHODS: Adults aged 30-50 years, at risk of type 2 diabetes (T2DM) and/or cardiovascular disease (CVD), were recruited from twelve general practices in The Netherlands. They were randomized to the intervention (n = 314) or control group (n = 308). The intervention consisted of up to six face-to-face counseling sessions with a trained practice nurse, followed by three-monthly sessions by phone. Costs were collected using three-monthly retrospective questionnaires. Quality of life was measured with the EuroQol-5D-3L, at baseline, 6, 12 and 24 months. Nine-year risk of developing T2DM and ten-year risk of CVD mortality were estimated using the ARIC and SCORE formulae, respectively, based on measurements at baseline and 24 months while applying a fixed age of 60 years at both time points.RESULTS: Small, statistically non-significant differences in effects were found between the intervention and control group with regard to risk scores and Quality Adjusted Life Years (QALYs) gained. The mean difference in costs between the intervention and control group was €-866 (95% confidence interval -2372; 370). The probability that the intervention was cost-effective varied from 93% at €8000/QALY to 88% at €80,000/QALY.CONCLUSION: A primary care lifestyle intervention aimed at adults at increased risk of T2DM and/or CVD could result in cost savings over a two-year period. However, due to methodological uncertainty no advice can be given regarding the implementation of the intervention in Dutch general practices.TRIAL REGISTRATION: Current Controlled Trials ISRCTN59358434.
AB - BACKGROUND: Cost-effectiveness studies of lifestyle interventions in people at risk for lifestyle-related diseases, addressing 'real-world' implementation, are needed. This study examines the cost-effectiveness of a primary care intervention from a societal perspective, compared with provision of health brochures, alongside a randomized controlled trial.METHODS: Adults aged 30-50 years, at risk of type 2 diabetes (T2DM) and/or cardiovascular disease (CVD), were recruited from twelve general practices in The Netherlands. They were randomized to the intervention (n = 314) or control group (n = 308). The intervention consisted of up to six face-to-face counseling sessions with a trained practice nurse, followed by three-monthly sessions by phone. Costs were collected using three-monthly retrospective questionnaires. Quality of life was measured with the EuroQol-5D-3L, at baseline, 6, 12 and 24 months. Nine-year risk of developing T2DM and ten-year risk of CVD mortality were estimated using the ARIC and SCORE formulae, respectively, based on measurements at baseline and 24 months while applying a fixed age of 60 years at both time points.RESULTS: Small, statistically non-significant differences in effects were found between the intervention and control group with regard to risk scores and Quality Adjusted Life Years (QALYs) gained. The mean difference in costs between the intervention and control group was €-866 (95% confidence interval -2372; 370). The probability that the intervention was cost-effective varied from 93% at €8000/QALY to 88% at €80,000/QALY.CONCLUSION: A primary care lifestyle intervention aimed at adults at increased risk of T2DM and/or CVD could result in cost savings over a two-year period. However, due to methodological uncertainty no advice can be given regarding the implementation of the intervention in Dutch general practices.TRIAL REGISTRATION: Current Controlled Trials ISRCTN59358434.
KW - Adult
KW - Cardiovascular Diseases/economics
KW - Cost of Illness
KW - Cost-Benefit Analysis
KW - Diabetes Mellitus, Type 2/economics
KW - Directive Counseling
KW - Drug Costs
KW - Female
KW - Health Behavior
KW - Health Promotion/economics
KW - Health Services/economics
KW - Humans
KW - Life Style
KW - Male
KW - Middle Aged
KW - Netherlands
KW - Pamphlets
KW - Patient Education as Topic/economics
KW - Primary Health Care/economics
KW - Quality of Life
KW - Quality-Adjusted Life Years
U2 - 10.1186/1471-2296-14-45
DO - 10.1186/1471-2296-14-45
M3 - Article
C2 - 23557482
VL - 14
SP - 45
JO - BMC Family Practice
JF - BMC Family Practice
SN - 1471-2296
ER -