Economic evaluation of a lifestyle intervention in primary care to prevent type 2 diabetes mellitus and cardiovascular diseases: a randomized controlled trial

Marieke F van Wier; Jeroen Lakerveld; Sandra D M Bot; Mai J M Chinapaw; Giel Nijpels; Maurits W van Tulder

doi:https://doi.org/10.1186/1471-2296-14-45

Economic evaluation of a lifestyle intervention in primary care to prevent type 2 diabetes mellitus and cardiovascular diseases: a randomized controlled trial

Marieke F van Wier, Jeroen Lakerveld, Sandra D M Bot, Mai J M Chinapaw, Giel Nijpels, Maurits W van Tulder

Research output: Contribution to journal › Article › Academic › peer-review

15 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	45
Journal	BMC Family Practice
Volume	14
DOIs	https://doi.org/10.1186/1471-2296-14-45
Publication status	Published - 4 Apr 2013

Keywords

Adult
Cardiovascular Diseases
Cardiovascular Diseases/economics
Cost of Illness
Cost-Benefit Analysis
Diabetes Mellitus, Type 2
Diabetes Mellitus, Type 2/economics
Directive Counseling
Drug Costs
Female
Health Behavior
Health Promotion
Health Promotion/economics
Health Services
Health Services/economics
Humans
Journal Article
Life Style
Male
Middle Aged
Netherlands
Pamphlets
Patient Education as Topic
Patient Education as Topic/economics
Primary Health Care
Primary Health Care/economics
Quality of Life
Quality-Adjusted Life Years
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

https://doi.org/10.1186/1471-2296-14-45

Cite this

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title = "Economic evaluation of a lifestyle intervention in primary care to prevent type 2 diabetes mellitus and cardiovascular diseases: a randomized controlled trial",

abstract = "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.",

keywords = "Adult, Cardiovascular Diseases, Cardiovascular Diseases/economics, Cost of Illness, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Diabetes Mellitus, Type 2/economics, Directive Counseling, Drug Costs, Female, Health Behavior, Health Promotion, Health Promotion/economics, Health Services, Health Services/economics, Humans, Journal Article, Life Style, Male, Middle Aged, Netherlands, Pamphlets, Patient Education as Topic, Patient Education as Topic/economics, Primary Health Care, Primary Health Care/economics, Quality of Life, Quality-Adjusted Life Years, Randomized Controlled Trial, Research Support, Non-U.S. Gov't",

author = "{van Wier}, {Marieke F} and Jeroen Lakerveld and Bot, {Sandra D M} and Chinapaw, {Mai J M} and Giel Nijpels and {van Tulder}, {Maurits W}",

year = "2013",

month = apr,

day = "4",

doi = "https://doi.org/10.1186/1471-2296-14-45",

language = "English",

volume = "14",

pages = "45",

journal = "BMC Family Practice",

issn = "1471-2296",

publisher = "BioMed Central",

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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

KW - Cardiovascular Diseases/economics

KW - Cost of Illness

KW - Cost-Benefit Analysis

KW - Diabetes Mellitus, Type 2

KW - Diabetes Mellitus, Type 2/economics

KW - Directive Counseling

KW - Drug Costs

KW - Female

KW - Health Behavior

KW - Health Promotion

KW - Health Promotion/economics

KW - Health Services

KW - Health Services/economics

KW - Humans

KW - Journal Article

KW - Life Style

KW - Male

KW - Middle Aged

KW - Netherlands

KW - Pamphlets

KW - Patient Education as Topic

KW - Patient Education as Topic/economics

KW - Primary Health Care

KW - Primary Health Care/economics

KW - Quality of Life

KW - Quality-Adjusted Life Years

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - https://doi.org/10.1186/1471-2296-14-45

DO - https://doi.org/10.1186/1471-2296-14-45

M3 - Article

C2 - 23557482

SN - 1471-2296

VL - 14

SP - 45

JO - BMC Family Practice

JF - BMC Family Practice

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