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Lim RSM, Gardner DSL, Bee YM, Cheung YB, Bairavi J, Gandhi M, Goh SY, Ho ETL, Lin X, Tan NC, Tay TL, Finkelstein EA. TRIal to slow the Progression Of Diabetes (TRIPOD): study protocol for a randomized controlled trial using wireless technology and incentives. Trials 2019; 20:650. [PMID: 31779678 PMCID: PMC6883710 DOI: 10.1186/s13063-019-3749-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/23/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The outcomes for those with type 2 diabetes mellitus (T2DM) in Singapore are poor. In this TRIal to slow the Progression Of Diabetes (TRIPOD), we will evaluate the effectiveness and cost-effectiveness of a comprehensive diabetes management package (DMP), with or without a financial incentives program, M-POWER Rewards, in efforts to improve HbA1c levels for individuals with T2DM. METHODS/DESIGN TRIPOD is a randomized, open-label, controlled, multi-center, superiority trial with three parallel arms: (1) usual care only, (2) usual care with DMP, and (3) usual care with DMP plus M-POWER Rewards. A total of 339 adults with sub-optimally controlled T2DM (self-reported HbA1c 7.5-11.0%) will be block randomized according to a 1:1:1 allocation ratio to the three arms. The primary outcome is mean change in HbA1c level at Month 12 from baseline. Secondary outcomes include mean change in HbA1c level at Months 6, 18, and 24; mean changes at Months 6, 12, 18, and 24 in weight, blood pressure, and self-reported physical activity, weight monitoring, blood glucose monitoring, medication adherence, diabetes self-management, sleep quality, work productivity and daily activity impairment, and health utility index; and proportion of participants initiating insulin treatment by Months 6, 12, 18, and 24. Incremental cost-effectiveness ratios will be computed based on costs per improvement in HbA1c at Month 12 and converted to cost per quality-adjusted life year gained. DISCUSSION The TRIPOD study will present insights about the long-term cost-effectiveness and financial viability of the interventions and the potential for integrating within usual care. TRIAL REGISTRATION ClinicalTrials.gov, NCT03800680. Registered on 11 January 2019.
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Affiliation(s)
- Robyn Su May Lim
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Daphne Su Lyn Gardner
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Yin Bun Cheung
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Joann Bairavi
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Biostatistics, Singapore Clinical Research Institute, 31 Biopolis Way, Singapore, 138669 Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Emily Tse Lin Ho
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Xinyi Lin
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609 Singapore
| | - Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, 167 Jalan Bukit Merah, Singapore, 150167 Singapore
| | - Tunn Lin Tay
- Department of Endocrinology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
| | - Eric Andrew Finkelstein
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
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Wang H, Kenkel D, Graham ML, Paul LC, Folta SC, Nelson ME, Strogatz D, Seguin RA. Cost-effectiveness of a community-based cardiovascular disease prevention intervention in medically underserved rural areas. BMC Health Serv Res 2019; 19:315. [PMID: 31096977 PMCID: PMC6524317 DOI: 10.1186/s12913-019-4117-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background Rural women experience health disparities in terms of cardiovascular disease (CVD) risk compared to urban women. Cost-effective CVD-prevention programs are needed for this population. The objective of this study was to conduct cost analysis and cost-effectiveness analyses (CEAs) of the Strong Hearts, Healthy Communities (SHHC) program compared to a control program in terms of change in CVD risk factors, including body weight and quality-adjusted life years (QALYs). Methods Sixteen medically underserved rural towns in Montana and New York were randomly assigned to SHHC, a six-month twice-weekly experiential learning lifestyle program focused predominantly on diet and physical activity behaviors (n = 101), or a monthly healthy lifestyle education-only control program (n = 93). Females who were sedentary, overweight or obese, and aged 40 years or older were enrolled. The cost analysis calculated the total and per participant resource costs as well as participants’ costs for the SHHC and control programs. In the intermediate health outcomes CEAs, the incremental costs were compared to the incremental changes in the outcomes. The QALY CEA compares the incremental costs and effectiveness of a national SHHC intervention for a hypothetical cohort of 2.2 million women compared to the status quo alternative. Results The resource cost of SHHC was $775 per participant. The incremental cost-effectiveness ratios from the payer’s perspective was $360 per kg of weight loss. Over a 10-year time horizon, to avert per QALY lost SHHC is estimated to cost $238,271 from the societal perspective, but only $62,646 from the healthcare sector perspective. Probabilistic sensitivity analyses show considerable uncertainty in the estimated incremental cost-effectiveness ratios. Conclusions A national SHHC intervention is likely to be cost-effective at willingness-to-pay thresholds based on guidelines for federal regulatory impact analysis, but may not be at commonly used lower threshold values. However, it is possible that program costs in rural areas are higher than previously studied programs in more urban areas, due to a lack of staff and physical activity resources as well as availability for partnerships with existing organizations. Trial registration ClinicalTrials.gov identifier NCT02499731, registered on July 16, 2015.
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Affiliation(s)
- Hua Wang
- Cornell University, 292 Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA.
| | - Donald Kenkel
- Cornell University, 2310 Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA
| | | | - Lynn C Paul
- Montana State University, 322 Reid Hall, Bozeman, MT, 59717, USA
| | - Sara C Folta
- Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | | | - David Strogatz
- Bassett Research Institute, One Atwell Rd, Cooperstown, NY, 13326, USA
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Lee JT, Lawson KD, Wan Y, Majeed A, Morris S, Soljak M, Millett C. Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence. Prev Med 2017; 99:49-57. [PMID: 28087465 DOI: 10.1016/j.ypmed.2017.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/15/2016] [Accepted: 01/09/2017] [Indexed: 11/25/2022]
Abstract
The World Health Organization recommends that countries implement population-wide cardiovascular disease (CVD) risk assessment and management programmes. The aim of this study was to conduct a systematic review to evaluate whether this recommendation is supported by cost-effectiveness evidence. Published economic evaluations were identified via electronic medical and social science databases (including Medline, Web of Science, and the NHS Economic Evaluation Database) from inception to March 2016. Study quality was evaluated using a modified version of the Consolidated Health Economic Evaluation Reporting Standards. Fourteen economic evaluations were included: five studies based on randomised controlled trials, seven studies based on observational studies and two studies using hypothetical modelling synthesizing secondary data. Trial based studies measured CVD risk factor changes over 1 to 3years, with modelled projections of longer term events. Programmes were either not, or only, cost-effective under non-verified assumptions such as sustained risk factor changes. Most observational and hypothetical studies suggested programmes were likely to be cost-effective; however, study deigns are subject to bias and subsequent empirical evidence has contradicted key assumptions. No studies assessed impacts on inequalities. In conclusion, recommendations for population-wide risk assessment and management programmes lack a robust, real world, evidence basis. Given implementation is resource intensive there is a need for robust economic evaluation, ideally conducted alongside trials, to assess cost effectiveness. Further, the efficiency and equity impact of different delivery models should be investigated, and also the combination of targeted screening with whole population interventions recognising that there multiple approaches to prevention.
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Affiliation(s)
- John Tayu Lee
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Kenny D Lawson
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia; Centre for Research Excellence in Chronic Disease Prevention, Public Health and Tropical Medicine, James Cook University, Cairns, Australia
| | - Yizhou Wan
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Michael Soljak
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Hagberg LA, Lindholm L. Review Article: Cost-effectiveness of healthcare-based interventions aimed at improving physical activity. Scand J Public Health 2016; 34:641-53. [PMID: 17132598 DOI: 10.1080/14034940600627853] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: This article aims to review current knowledge concerning the cost-effectiveness of healthcare-based interventions aimed at improving physical activity. Method: A search was performed for economic evaluations containing the terms ``physical activity'', ``exercise'', or ``fitness''. Cost-effectiveness for the articles found was described based on a model for evaluating interventions intended to promote physical activity. Results: A total of 26 articles were found in the search. Nine of them concern a general population, 7 evaluated older people, and 10 studied disease-specific populations. A preventive perspective is most common, but some have a treatment perspective. Around 20 of the interventions studied were cost-effective according to their authors, but all analyses had some shortcomings in their evaluation methods. Conclusion: This review found many examples of cost-effective interventions. There is a lack of evidence for the cost-effectiveness of interventions aimed at those whose only risk factor for illness is a sedentary lifestyle. There is more evidence, although it is limited, for the cost-effectiveness of interventions aimed at high-risk groups or those who manifest poor health related to physical inactivity. Most of the evidence for cost-effectiveness is for older people and those with heart failure. Promotion of physical activity can be cost-effective with different methods and in different settings, but there remains a lack of evidence for specific methods in specific populations.
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Affiliation(s)
- Lars A Hagberg
- Orebro County Council, Department of Public Health, Orebro, Sweden.
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Kamboj L, Oh P, Levine M, Kammila S, Casey W, Harterre D, Goeree R. Cost effectiveness of a systematic guidelines-based approach to the prevention and management of vascular disease in a primary care setting. Int J Cardiol 2015; 203:893-9. [PMID: 26613572 DOI: 10.1016/j.ijcard.2015.11.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/24/2015] [Accepted: 11/04/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Ontario, Canada, the Comprehensive Vascular Disease Prevention and Management Initiative (CVDPMI) was undertaken to improve the vascular health in communities. The CVDPMI significantly improved cardiovascular (CV) risk factor profiles from baseline to follow-up visits including the 10 year Framingham Risk Score (FRS). Although the CVDPMI improved CV risk, the economic value of this program had not been evaluated. METHODS We examined the cost effectiveness of the CVDPMI program compared to no CVDPMI program in adult patients identified at risk for an initial or subsequent vascular event in a primary care setting. A one year and a ten year cost effectiveness analyses were conducted. To determine the uncertainty around the cost per life year gained ratio, a non-parametric bootstrap analysis was conducted. RESULTS The overall population base case analysis at one year resulted in a cost per CV event avoided of $70,423. FRS subgroup analyses showed the high risk cohort (FRS >20%) had an incremental cost effectiveness ratio (ICER) that was dominant. In the moderate risk subgroup (FRS 10%-20%) the ICER was $47,439 per CV event avoided and the low risk subgroup (FRS <10%) showed a highly cost ineffective result of greater than $5 million per CV event avoided. The ten year analysis resulted in a dominant ICER. CONCLUSIONS At one year, the CVDPMI program is economically acceptable for patients at moderate to high risk for CV events. The CVDPMI results in increased life expectancy at an incremental cost saving to the healthcare system over a ten year period.
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Affiliation(s)
- Laveena Kamboj
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
| | - Paul Oh
- University Health Network, 550 University Ave, Toronto, ON M5G 2A2, Canada.
| | - Mitchell Levine
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
| | - Srinu Kammila
- Peterborough Regional Nephrology Associates, 239 Charlotte St, Peterborough, ON K9J 2V1, Canada.
| | - William Casey
- Primary Health Care Services of Peterborough, 150 King Street, Peterborough, ON K9J 2R9, Canada.
| | - Don Harterre
- Primary Health Care Services of Peterborough, 150 King Street, Peterborough, ON K9J 2R9, Canada.
| | - Ron Goeree
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
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Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): a randomized controlled trial of a six month pedometer program with financial incentives. Contemp Clin Trials 2015; 41:238-47. [PMID: 25666856 DOI: 10.1016/j.cct.2015.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 11/22/2022]
Abstract
Non-communicable diseases (NCDs) are emerging as the predominant global health challenge of this century. Physical inactivity is one of the primary risk factors for NCDs. Therefore, increasing physical activity levels is a public health imperative. The arrival of affordable wearable technologies, such as wireless pedometers, provides one strategy for encouraging walking. However, the effectiveness of these technologies in promoting sustained behavior change has not been established. Insights from economics suggest that incentives may be a useful strategy for increasing maintenance and effectiveness of behavior change interventions, including physical activity interventions that rely on wearable technologies. The aim of this trial is to test the effectiveness of a common wireless pedometer with or without one of two types of incentives (cash or donations to charity) for reaching weekly physical activity goals. We present here the design and baseline characteristics of participants of this four arm randomized controlled trial. 800 full-time employees (desk-bound office workers) belonging to 15 different worksites (on average, 53 (sd: 37) employees at each worksite) were successfully randomized to one of four study arms. If shown to be effective, wearable technologies in concert with financial incentives may provide a scalable and affordable health promotion strategy for governments and employers seeking to increase the physical activity levels of their constituents.
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A naturopathic approach to the prevention of cardiovascular disease: cost-effectiveness analysis of a pragmatic multi-worksite randomized clinical trial. J Occup Environ Med 2014; 56:171-6. [PMID: 24451612 PMCID: PMC3921268 DOI: 10.1097/jom.0000000000000066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of a worksite-based naturopathic (individualized lifestyle counseling and nutritional medicine) approach to primary prevention of cardiovascular disease (CVD). METHODS Economic evaluation alongside a pragmatic, multi-worksite, randomized controlled trial comparing enhanced usual care (EUC; usual care plus biometric screening) to the addition of a naturopathic approach to CVD prevention (NC+EUC). RESULTS After 1 year, NC+EUC resulted in a net decrease of 3.3 (confidence interval: 1.7 to 4.8) percentage points in 10-year CVD event risk (number needed to treat = 30). These risk reductions came with average net study-year savings of $1138 in societal costs and $1187 in employer costs. There was no change in quality-adjusted life years across the study year. CONCLUSIONS A naturopathic approach to CVD primary prevention significantly reduced CVD risk over usual care plus biometric screening and reduced costs to society and employers in this multi-worksite-based study. Trial Registration clinicaltrials.gov Identifier: NCT00718796.
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Rees G, Mellor D, Holloway EE, Sturrock BA, Hegel MT, Casten R, Xie J, Finkelstein E, Lamoureux E, Keeffe JE. Integrated depression management: a proposed trial of a new model of care in a low vision rehabilitation setting. Ophthalmic Epidemiol 2014; 20:321-9. [PMID: 24070104 DOI: 10.3109/09286586.2013.787102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE Depression is a common problem among people with visual impairment and contributes to functional decline. This article presents a study protocol to evaluate a new model of care for those patients with depressive symptoms in which psychological treatment is integrated into low vision rehabilitation services. Low vision staff will be trained to deliver "problem solving therapy for primary care" (PST-PC), an effective psychological treatment developed specifically for delivery by non-mental health care staff. PST-PC is delivered in 8 weekly telephone sessions of 30-45 minutes duration and 4 monthly maintenance sessions. We predict this new integrated model of care will significantly reduce depressive symptoms and improve the quality of life for people with visual impairment. METHODS AND DESIGN A randomized controlled trial of PST-PC will be implemented nationally across low vision rehabilitation services provided by Vision Australia. Clients who screen positive for depressive symptoms and meet study criteria will be randomized to receive PST-PC or usual care, consisting of a referral to their general practitioner for more detailed assessment and treatment. Outcome measures include depressive symptoms and behaviors, quality of life, coping and psychological adjustment to visual impairment. Masked assessments will take place pre- and post-intervention as well as at 6- and 12-month follow-up. CONCLUSION We anticipate that this innovative service delivery model will lead to sustained improvements in clients' quality of life in a cost effective manner and provide an innovative service delivery model suitable for other health care areas in which depression is co-morbid.
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Affiliation(s)
- Gwyneth Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Australia
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Finkelstein EA, Khavjou OA, Will JC, Farris RP, Prabhu M. Assessing the ability of cardiovascular disease risk calculators to evaluate effectiveness of trials and interventions. Expert Rev Pharmacoecon Outcomes Res 2014; 6:417-24. [DOI: 10.1586/14737167.6.4.417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wolfenstetter SB, Wenig CM. Costing of physical activity programmes in primary prevention: a review of the literature. HEALTH ECONOMICS REVIEW 2011; 1:17. [PMID: 22827967 PMCID: PMC3402935 DOI: 10.1186/2191-1991-1-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/26/2011] [Indexed: 05/07/2023]
Abstract
This literature review aims to analyse the costing methodology in economic analyses of primary preventive physical activity programmes. It demonstrates the usability of a recently published theoretical framework in practice, and may serve as a guide for future economic evaluation studies and for decision making.A comprehensive literature search was conducted to identify all relevant studies published before December 2009. All studies were analysed regarding their key economic findings and their costing methodology.In summary, 18 international economic analyses of primary preventive physical activity programmes were identified. Many of these studies conclude that the investigated intervention provides good value for money compared with alternatives (no intervention, usual care or different programme) or is even cost-saving. Although most studies did provide a description of the cost of the intervention programme, methodological details were often not displayed, and savings resulting from the health effects of the intervention were not always included sufficiently.This review shows the different costing methodologies used in the current health economic literature and compares them with a theoretical framework. The high variability regarding the costs assessment and the lack of transparency concerning the methods limits the comparability of the results, which points out the need for a handy minimal dataset of cost assessment.
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Affiliation(s)
- Silke B Wolfenstetter
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Christina M Wenig
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Institute of Health Economics and Health Care Management and Munich Center of Health Sciences, Ludwigstr. 28 RG, 80539 Munich, Germany
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Ritzwoller DP, Sukhanova AS, Glasgow RE, Strycker LA, King DK, Gaglio B, Toobert DJ. Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: economic analysis of ¡Viva Bien! Transl Behav Med 2011; 1:427-435. [PMID: 22081776 DOI: 10.1007/s13142-011-0037-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Information on cost-effectiveness of multiple-risk-factor lifestyle interventions for Latinas with diabetes is lacking. The aim of this paper is to evaluate costs and cost-effectiveness for ¡Viva Bien!, a randomized trial targeting Latinas with type 2 diabetes. We estimated 6-month costs; calculated incremental costs per behavioral, biologic, and quality-of-life change; and performed sensitivity analyses from health plan and participant perspectives. Recruitment, intervention, and participant costs were estimated at $45,896, $432,433, and $179,697, respectively. This translates to $4,634 in intervention costs per ¡Viva Bien! participant; $7,723 in both per unit reduction in hemoglobin A1c and per unit reduction in body mass index. Although costs may be higher than interventions that address one risk factor, potential risks for longer-term health-care costs are high for this at-risk group. Given the benefits of ¡Viva Bien!, cost reductions are recommended to enhance its efficiency, adoption, and long-term maintenance without diluting its effectiveness.
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Affiliation(s)
- Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, P.O. Box378066, Denver, CO 80237-8066, USA
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Moya Martínez P, Sánchez López M, López Bastida J, Escribano Sotos F, Notario Pacheco B, Salcedo Aguilar F, Martínez Vizcaíno V. [Cost-effectiveness of an intervention to reduce overweight and obesity in 9-10-year-olds. The Cuenca study]. GACETA SANITARIA 2011; 25:198-204. [PMID: 21324563 DOI: 10.1016/j.gaceta.2010.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 10/25/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children. METHODS Standard cost effectiveness analysis methods and two perspectives (societal and institutional) were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10 control schools (718 children) was performed. Net costs were calculated by subtracting the usual after-school care cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group. RESULTS The intervention costs totaled 125,469.75€, representing 269.83 €/year/child. The usual after-school care was estimated at 844,56 €/year/child. Intervention children showed a decrease in triceps skinfold thickness (-1.25mm, 95% CI: -1.82 to -0.67; P<.001). Intervention children with body mass index (BMI) between the percentiles 25 and 75 showed a decrease in the percentage of body fat (-0.59%; 95% CI: -1.03 to -0.67; P<.001), and those with a BMI>P75 showed a decrease in triceps skinfold thickness (-1.87mm; 95%CI: -3.43 to -0.32; P<.001), and percentage of body fat (-0.67%; 95%CI: -1.32 to -0.01; P<.05). CONCLUSIONS This type of after-school program for recreational physical activity to prevent obesity are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners.
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Affiliation(s)
- Pablo Moya Martínez
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, España.
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Saha S, Gerdtham UG, Johansson P. Economic evaluation of lifestyle interventions for preventing diabetes and cardiovascular diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:3150-95. [PMID: 20948954 PMCID: PMC2954575 DOI: 10.3390/ijerph7083150] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 07/23/2010] [Accepted: 08/05/2010] [Indexed: 12/21/2022]
Abstract
Lifestyle interventions (i.e., diet and/or physical activity) are effective in delaying or preventing the onset of diabetes and cardiovascular disease. However, policymakers must know the cost-effectiveness of such interventions before implementing them at the large-scale population level. This review discusses various issues (e.g., characteristics, modeling, and long-term effectiveness) in the economic evaluation of lifestyle interventions for the primary and secondary prevention of diabetes and cardiovascular disease. The diverse nature of lifestyle interventions, i.e., type of intervention, means of provision, target groups, setting, and methodology, are the main obstacles to comparing evaluation results. However, most lifestyle interventions are among the intervention options usually regarded as cost-effective. Diabetes prevention programs, such as interventions starting with targeted or universal screening, childhood obesity prevention, and community-based interventions, have reported favorable cost-effectiveness ratios.
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Affiliation(s)
- Sanjib Saha
- Centre for Primary Health Care Research, Lund University, Lund, Sweden
- Health Economics & Management, Institute of Economic Research, Lund University, Lund, Sweden
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +46-766-486-666; Fax: +46-462-224-118
| | - Ulf-G Gerdtham
- Centre for Primary Health Care Research, Lund University, Lund, Sweden
- Health Economics & Management, Institute of Economic Research, Lund University, Lund, Sweden
- Department of Economics, Lund University, Lund, Sweden; E-Mail:
| | - Pia Johansson
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; E-Mail:
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Wolfenstetter SB, Wenig CM. Economic evaluation and transferability of physical activity programmes in primary prevention: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1622-48. [PMID: 20617050 PMCID: PMC2872359 DOI: 10.3390/ijerph7041622] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 03/29/2010] [Accepted: 04/06/2010] [Indexed: 11/28/2022]
Abstract
This systematic review aims to assess the characteristics of, and the clinical and economic evidence provided by, economic evaluations of primary preventive physical exercise interventions, and to analyse their transferability to Germany using recommended checklists. Fifteen economic evaluations from seven different countries met eligibility criteria, with seven of the fifteen providing high economic evidence in the special country context. Most of the identified studies conclude that the investigated intervention provide good value for money compared with alternatives. However, this review shows a high variability of the costing methods between the studies, which limits comparability, generalisability and transferability of the results.
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Affiliation(s)
- Silke B. Wolfenstetter
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; E-Mail:
| | - Christina M. Wenig
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; E-Mail:
- Ludwig-Maximilians-Universität München, Institute of Health Economics and Health Care Management and Munich Center of Health Sciences, Ludwigstr. 28 RG, 80539 München, Germany
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15
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Lange J, Evans-Benard S, Cooper J, Fahey E, Kalapos M, Tice D, Wang-D'Amato N, Watsky N. Puerto Rican Women’s Perceptions of Heart Disease Risk. Clin Nurs Res 2009; 18:291-306. [DOI: 10.1177/1054773809346539] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Women frequently fail to recognize that coronary heart disease (CHD), not breast cancer, is the primary cause of female mortality. CHD mortality among U.S. mainland Puerto Rican (PR) women is second only to African American women. It is unknown what PR women understand about their risk, what factors they believe contribute to CHD, or whether they know the atypical symptoms often experienced by women. Most CHD studies exclude Hispanic women. Those that do often aggregate their results, making subgroup variations invisible. This study explored awareness of CHD symptoms, risks, and help-seeking behaviors among 12 PR women. Focus group methodology revealed that participants were unaware of their risk and had misconceptions about CHD symptoms and contributing factors. Barriers to early recognition and treatment included lack of knowledge, gender role conflict (caregiver vs. care recipient), and fears of falsely alarming family members or the embarrassment of feeling “dismissed” by health care providers.
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16
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Khavjou OA, Finkelstein EA, Farris R, Will JC. Recall of Three Heart Disease Risk Factor Diagnoses among Low-Income Women. J Womens Health (Larchmt) 2009; 18:667-75. [DOI: 10.1089/jwh.2008.0907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Olga A. Khavjou
- RTI International, Health, Social, and Economics Research, Washington, DC, and Research Triangle Park, North Carolina
| | - Eric A. Finkelstein
- RTI International, Health, Social, and Economics Research, Washington, DC, and Research Triangle Park, North Carolina
| | - Rosanne Farris
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia
| | - Julie C. Will
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia
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17
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Gordon L, Graves N, Hawkes A, Eakin E. A review of the cost-effectiveness of face-to-face behavioural interventions for smoking, physical activity, diet and alcohol. Chronic Illn 2007; 3:101-29. [PMID: 18083667 DOI: 10.1177/1742395307081732] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the evidence for the cost-effectiveness of health behaviour interventions that address the major behavioural risk factors for chronic disease, including smoking, physical inactivity, poor diet, and alcohol misuse. METHODS Medical and economic databases were searched for relevant economic evaluations. Studies were critically appraised using a published 35-point checklist, and the results are described using a narrative approach, noting methodological limitations. The review included 64 studies from 1995-2005, including 17 reports on multiple behaviour interventions. RESULTS There was considerable variation among the studies by target populations, intervention components, primary outcomes, and economic methods, but the reported incremental cost-effectiveness ratios were consistently low (e.g. <14,000 Euros per quality-adjusted life-year gained for smoking-cessation programmes in 2006 Euros) as compared to certain preventive pharmaceutical and invasive interventions. Interventions targeting high-risk-population subgroups were relatively better value for money as compared to those targeting general populations. DISCUSSION In general, the results of this review demonstrate favourable cost-effectiveness for smoking interventions, physical activity interventions and multiple behaviour interventions in high-risk groups. Although alcohol and dietary interventions appeared to be economically favourable, it is difficult to draw conclusions because of the variety in study outcomes. However, methodological limitations weaken the generalizability of findings, and suggest that the results of any given study should be considered carefully when being used to inform resource allocation.
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Affiliation(s)
- L Gordon
- Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Brisbane, Q4029, Australia.
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18
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Finkelstein EA, Khavjou O, Will JC. Cost-effectiveness of WISEWOMAN, a program aimed at reducing heart disease risk among low-income women. J Womens Health (Larchmt) 2006; 15:379-89. [PMID: 16724886 DOI: 10.1089/jwh.2006.15.379] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To quantify the cost-effectiveness of the WISEWOMAN program. WISEWOMAN is a Centers for Disease Control and Prevention (CDC)-funded lifestyle intervention program that provides low-income uninsured women aged 40-64 with chronic disease risk factor screenings, lifestyle interventions, and referral services in an effort to prevent coronary heart disease (CHD) and improve health. METHODS We used data for 3015 WISEWOMAN participants who completed baseline and 1-year follow-up screenings. We quantified the average per capita cost of providing WISEWOMAN over the last 6 months of the reporting period. We assessed 1-year reductions in select CHD risk factors. We calculated the cost-effectiveness ratio by dividing the average per capita cost by average predicted life-years gained. RESULTS The cost of providing WISEWOMAN services to each additional participant averaged 270 US dollars per participant. Participants significantly improved their systolic (1.3%) and diastolic (1.7%) blood pressure, total (2%) and high-density lipoprotein (HDL) (0.7%) cholesterol, and 10-year risk of CHD (8.7%). There were also significant reductions in percent of women who smoked (11.7%) or had high blood pressure (15.8%) or high cholesterol (13.1%). The bestcase cost-effectiveness ratio was 470 US dollars per percentage point reduction in CHD risk, or 4400 US dollars per discounted life-year gained; however, sensitivity analysis revealed substantial uncertainty around this estimate. CONCLUSIONS Although more research is needed to confirm the assumptions used in the model, results of our analysis suggest that the WISEWOMAN program is a cost-effective approach for reducing CVD risk among low-income, uninsured women aged 40-64, especially if improvements in risk factors are sustainable when program participation concludes.
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Affiliation(s)
- Eric A Finkelstein
- RTI International, Health, Social, and Economics Research, Research Triangle Park, North Carolina 27709, USA.
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Abstract
The authors examine whether retrospective claims data are useful to distinguish future high-cost cases among the uninsured. They rely on internal claims and accounting data for the calendar years from 1999 to 2001 from a representative safety net facility to describe the distribution of costs and any characteristics that distinguish high-cost patients from other uninsured patients. They conclude that administrative data combined with in-depth survey information could be a useful approach for identifying cases for intensive case management.
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Finkelstein EA, Wittenborn JS, Farris RP. Evaluation of Public Health Demonstration Programs: The Effectiveness and Cost-Effectiveness of WISEWOMAN. J Womens Health (Larchmt) 2004; 13:625-33. [PMID: 15257854 DOI: 10.1089/1540999041281043] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In today's healthcare environment, public health resources are scarce. Thus, interventions to improve the public's health must be rigorously evaluated to ensure that they make the best use of available resources. METHODS The Centers for Disease Control and Prevention (CDC) provides a general framework for program evaluation. This paper presents additional details on several key evaluation areas within CDC's framework. RESULTS Successful evaluations will be built into the program design; will be multifaceted, incorporating both quantitative and qualitative methods; will assess both process and outcome measures; and will engage stakeholders to ensure utility of results. CONCLUSIONS Well-planned evaluations can lead to less burdensome yet more effective assessment and better program performance and can increase the knowledge base for health promotion practice.
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Affiliation(s)
- Eric A Finkelstein
- RTI International, Health, Social and Economics Research, Research Triangle Park, North Carolina 27709, USA.
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