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Alshowair A, Altamimi S, Alruhaimi FA, Alshahrani S, Alsuwailem F, Alkhaldi M, Abdalla H, Alkhuraiji FH, Alaqeel MS, Almureef SS, Alhawasy S, Abdel-Azeem A. Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:211-223. [PMID: 38596283 PMCID: PMC11001564 DOI: 10.2147/ceor.s451739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM). Methods This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP). Results Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient. Conclusion MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.
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Affiliation(s)
- Abdulmajeed Alshowair
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Saleh Altamimi
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal A Alruhaimi
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alshahrani
- Academic and Training Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Fatima Alsuwailem
- Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Mona Alkhaldi
- Health Administration Office, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Haiam Abdalla
- Model of Care, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | | | - Montaser Saad Alaqeel
- Financial Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | | | - Salman Alhawasy
- Reporting Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Amro Abdel-Azeem
- Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine Zagazig University, Zagazig, Egypt
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Xiong Y, Huo Z, Wong SYS, Yip BHK. Cost effectiveness of nonpharmacological prevention programs for diabetes: A systematic review of trial-based studies. Chronic Dis Transl Med 2024; 10:12-21. [PMID: 38450300 PMCID: PMC10914011 DOI: 10.1002/cdt3.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 03/08/2024] Open
Abstract
Trial-based economic value of prevention programs for diabetes is inexplicit. We aimed to review the cost-effectiveness of nonpharmacological interventions to prevent type-2 diabetes mellitus (T2DM) for high-risk people. Six electronic databases were searched up to March 2022. Studies assessing both the cost and health outcomes of nonpharmacological interventions for people at high-risk of T2DM were included. The quality of the study was assessed by the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. The primary outcome for synthesis was incremental cost-effectiveness ratios (ICER) for quality-adjusted life years (QALYs), and costs were standardized in 2022 US dollars. Narrative synthesis was performed, considering different types and delivery methods of interventions. Sixteen studies included five based on the US diabetes prevention program (DPP), six on non-DPP-based lifestyle interventions, four on health education, and one on screening plus lifestyle intervention. Compared with usual care, lifestyle interventions showed higher potential of cost-effectiveness than educational interventions. Among lifestyle interventions, DPP-based programs were less cost-effective (median of ICERs: $27,077/QALY) than non-DPP-based programs (median of ICERs: $1395/QALY) from healthcare perspectives, but with larger decreases in diabetes incidence. Besides, the cost-effectiveness of interventions was more possibly realized through the combination of different delivery methods. Different interventions to prevent T2DM in high-risk populations are both cost-effective and feasible in various settings. Nevertheless, economic evidence from low- and middle-income countries is still lacking, and interventions delivered by trained laypersons and combined with peer support sessions or mobile technologies could be potentially a cost-effective solution in such settings with limited resources.
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Affiliation(s)
- Yongyi Xiong
- Jockey Club School of Public Health and Primary Care, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
| | - Zhaohua Huo
- Jockey Club School of Public Health and Primary Care, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
| | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
| | - Benjamin H. K. Yip
- Jockey Club School of Public Health and Primary Care, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
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3
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Baris VK, Seren Intepeler S. Evaluation of the cost-effectiveness of a multicomponent fall prevention program in hospitalized patients. Nurs Health Sci 2023; 25:585-596. [PMID: 37706623 DOI: 10.1111/nhs.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/10/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
The aim of this pre- and post-interventional study was to analyze the cost-effectiveness of the multicomponent fall prevention program in hospitalized patients. To achieve this aim, cost-effectiveness analysis performed using decision tree modeling was compared with the implementation of the fall prevention program and usual care. The primary outcome was the number of patient falls. The uncertainty in cost and effectiveness data was evaluated using one-way sensitivity analysis, best-worst-case scenario analysis, and probabilistic sensitivity analysis. According to cost-effectiveness analysis, implementation of the fall prevention program was dominantly cost-effective. As a result of the probabilistic sensitivity analysis, it was revealed that, even if willing-to-pay per-fall prevented value was 0, the probability of being cost-effective was 54.4% for the fall prevention program. Economic evaluation results showed that implementing the multicomponent fall prevention program was dominantly cost-effective in hospitalized patients. Nurses and nurse managers can benefit from economic evaluations in their decision-making processes to implement fall prevention programs.
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Affiliation(s)
- Veysel Karani Baris
- Nursing Faculty, Nursing Management Department, Dokuz Eylul University, Izmir, Turkey
| | - Seyda Seren Intepeler
- Nursing Faculty, Nursing Management Department, Dokuz Eylul University, Izmir, Turkey
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Nieuwenhuijse EA, Vos RC, van den Hout WB, Struijs JN, Verkleij SM, Busch K, Numans ME, Bonten TN. The Effect and Cost-Effectiveness of Offering a Combined Lifestyle Intervention for the Prevention of Cardiovascular Disease in Primary Care: Results of the Healthy Heart Stepped-Wedge Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5040. [PMID: 36981949 PMCID: PMC10048996 DOI: 10.3390/ijerph20065040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/04/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and cost-effectiveness of offering the combined lifestyle programme "Healthy Heart", addressing overweight, diet, physical activity, smoking and alcohol, to improve lifestyle behaviour and reduce cardiovascular risk. DESIGN A practice-based non-randomised stepped-wedge cluster trial with two-year follow-up. Outcomes were obtained via questionnaires and routine care data. A cost-utility analysis was performed. During the intervention period, "Healthy Heart" was offered during regular cardiovascular risk management consultations in primary care in The Hague, The Netherlands. The period prior to the intervention period served as the control period. RESULTS In total, 511 participants (control) and 276 (intervention) with a high cardiovascular risk were included (overall mean ± SD age 65.0 ± 9.6; women: 56%). During the intervention period, 40 persons (15%) participated in the Healthy Heart programme. Adjusted outcomes did not differ between the control and intervention period after 3-6 months and 12-24 months. Intervention versus control (95% CI) 3-6 months: weight: β -0.5 (-1.08-0.05); SBP β 0.15 (-2.70-2.99); LDL-cholesterol β 0.07 (-0.22-0.35); HDL-cholesterol β -0.03 (-0.10-0.05); physical activity β 38 (-97-171); diet β 0.95 (-0.93-2.83); alcohol OR 0.81 (0.44-1.49); quit smoking OR 2.54 (0.45-14.24). Results were similar for 12-24 months. Mean QALYs and mean costs of cardiovascular care were comparable over the full study period (mean difference (95% CI) QALYs: -0.10 (-0.20; 0.002); costs: EUR 106 (-80; 293)). CONCLUSIONS For both the shorter (3-6 months) and longer term (12-24 months), offering the Healthy Heart programme to high-cardiovascular-risk patients did not improve their lifestyle behaviour nor cardiovascular risk and was not cost-effective on a population level.
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Affiliation(s)
- Emma A. Nieuwenhuijse
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Rimke C. Vos
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Wilbert B. van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jeroen N. Struijs
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment, 3720 MA Bilthoven, The Netherlands
| | - Sanne M. Verkleij
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Karin Busch
- Hadoks Chronische Zorg BV, 2517 JK The Hague, The Netherlands
| | - Mattijs E. Numans
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Tobias N. Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Shearer J, Kalyani M, Mangelis A, de Silva D, de Silva P, Wijesuriya M, Karalliedde J. Cost-Effectiveness of Peer-Educator-Delivered Lifestyle Modification for Type 2 Diabetes Prevention in a Young Healthy Population in Sri Lanka: A Trial-Based Economic Evaluation and Economic Model. PHARMACOECONOMICS - OPEN 2021; 5:693-700. [PMID: 34254276 PMCID: PMC8611152 DOI: 10.1007/s41669-021-00284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study evaluated the cost effectiveness of an intensive lifestyle modification (LSM) intervention delivered by peer educators for the prevention of type 2 diabetes mellitus in a young at-risk population in a low healthcare resource setting. OBJECTIVE The aim of this study was to evaluate the short-term and long-term cost effectiveness of an intensive lifestyle modification intervention for type 2 diabetes prevention in a young urban at-risk population in Sri Lanka. METHODS This was an economic evaluation using cost and outcome data from a randomized controlled trial. We randomized 3539 healthy individuals aged 5-40 years with risk factors for type 2 diabetes to either 3-monthly (P-LSM n = 1727) or 12-monthly (C-LSM n = 1812) peer-educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity. A cost-effectiveness analysis was conducted from a health system perspective with outcomes expressed as disability-adjusted life-years (DALYs). Intervention costs and outcomes were collected during a median clinical trial period of 3 years and extrapolated to a lifetime horizon using economic modelling. Uncertainty in the lifetime model was explored by structural and probabilistic sensitivity analyses. RESULTS The costs of the more intensive peer support programme were partially offset by reduced costs of type 2 diabetes complications recorded over the trial period and completely offset by lifetime cost savings of 6000 LKR. The more intensive P-LSM also averted more DALYs, estimated at 0.456 DALYs over the lifetime of participants. CONCLUSIONS In a young at-risk Sri Lanka population, an intensive LSM programme was cost effective, averting more DALYs at an acceptable additional cost than a much less intensive LSM programme. Early intervention in young at-risk people represents good value for money from the Sri Lankan health care payer perspective.
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Affiliation(s)
- James Shearer
- King's Health Economics, Institute of Psychiatry, The David Goldberg Centre, Psychology and Neuroscience at King's College London, De Crespigny Park, Box P024, London, SE5 8AF, UK.
| | - Miral Kalyani
- London School of Hygiene and Tropical Medicine, London, UK
| | - Anastasios Mangelis
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Dileep de Silva
- Health Human Resources, Ministry of Health, Colombo, Sri Lanka
| | | | | | - Janaka Karalliedde
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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Li J, Sun L, Hou Y, Chen L. Cost-Effectiveness Analysis of a Mobile-Based Intervention for Patients with Type 2 Diabetes Mellitus. Int J Endocrinol 2021; 2021:8827629. [PMID: 34306072 PMCID: PMC8266460 DOI: 10.1155/2021/8827629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/10/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the cost effectiveness of a mobile-based intervention for patients with type 2 diabetes mellitus (T2DM) and compare it with the usual management mode. METHOD A total of 215 patients with T2DM in a tertiary-care hospital specific to diabetes were selected as the study population. This study was conducted from January 1, 2019 to January 1, 2020. Of the 215 patients, 130 were randomly assigned to the mHealth group and 85 were assigned to the usual care group. IBM SPSS 25.0 software was used for descriptive statistics, t tests, chi-square tests, and correlation analyses. Haemoglobin A1c (HbA1c) was the effectiveness parameter adopted. Cost-effectiveness analyses were performed, and incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS Of the 215 patients with T2DM, the proportion of male patients was 66.0%. The mean age of the patients was 47.2 (SD 9.95). Differences in baseline information were not statistically significant between the two groups (P > 0.05). At the 3-, 6-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA1c than the usual care group, 67.9% versus 46.2% (P < 0.001), 72.4% versus 45.4% (P < 0.001), and 74.6% versus 47.1% (P < 0.001), respectively. The value of HbA1c was positively related to total patient cost, material fee, Western medicine fee, and hospitalization expenses (P < 0.05), with correlation coefficients of 0.202, 0.200, 0.172, and 0.183, respectively. The costs of the mHealth group and usual care group were CNY¥ 1169.76 and CNY¥ 1775.44 per patient/year, respectively. The incremental cost of the mHealth intervention was CNY¥ -605.68 per patient/year. The ICER was CNY¥ -22.02 per patient/year. CONCLUSION Compared with the usual care mode, the mHealth management model for patients with T2DM improved the control rate of HbA1c, and the mHealth management mode had better cost effectiveness.
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Affiliation(s)
- Jing Li
- National Health Commission Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, No 6, Huanruibei Road, Beichen District, Tianjin 300134, China
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin 300070, China
| | - Yabing Hou
- School of Public Health, Tianjin Medical University, No 22, Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Liming Chen
- National Health Commission Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, No 6, Huanruibei Road, Beichen District, Tianjin 300134, China
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Zhou X, Siegel KR, Ng BP, Jawanda S, Proia KK, Zhang X, Albright AL, Zhang P. Cost-effectiveness of Diabetes Prevention Interventions Targeting High-risk Individuals and Whole Populations: A Systematic Review. Diabetes Care 2020; 43:1593-1616. [PMID: 33534726 DOI: 10.2337/dci20-0018] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We conducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations. RESEARCH DESIGN AND METHODS Interventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then treat them with either lifestyle or metformin interventions. Population-based prevention strategies are those that focus on the whole population regardless of the level of risk, creating public health impact through policy implementation, campaigns, and other environmental strategies. We systematically searched seven electronic databases for studies published in English between 2008 and 2017. We grouped lifestyle interventions targeting high-risk individuals by delivery method and personnel type. We used the median incremental cost-effectiveness ratio (ICER), measured in cost per quality-adjusted life year (QALY) or cost saved to measure the CE of interventions. We used the $50,000/QALY threshold to determine whether an intervention was cost-effective or not. ICERs are reported in 2017 U.S. dollars. RESULTS Our review included 39 studies: 28 on interventions targeting high-risk individuals and 11 targeting whole populations. Both lifestyle and metformin interventions in high-risk individuals were cost-effective from a health care system or a societal perspective, with median ICERs of $12,510/QALY and $17,089/QALY, respectively, compared with no intervention. Among lifestyle interventions, those that followed a Diabetes Prevention Program (DPP) curriculum had a median ICER of $6,212/QALY, while those that did not follow a DPP curriculum had a median ICER of $13,228/QALY. Compared with lifestyle interventions delivered one-on-one or by a health professional, those offered in a group setting or provided by a combination of health professionals and lay health workers had lower ICERs. Among population-based interventions, taxing sugar-sweetened beverages was cost-saving from both the health care system and governmental perspectives. Evaluations of other population-based interventions-including fruit and vegetable subsidies, community-based education programs, and modifications to the built environment-showed inconsistent results. CONCLUSIONS Most of the T2D prevention interventions included in our review were found to be either cost-effective or cost-saving. Our findings may help decision makers set priorities and allocate resources for T2D prevention in real-world settings.
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Affiliation(s)
- Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Boon Peng Ng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL
| | - Shawn Jawanda
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Krista K Proia
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xuanping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Duijzer G, Bukman AJ, Meints-Groenveld A, Haveman-Nies A, Jansen SC, Heinrich J, Hiddink GJ, Feskens EJM, de Wit GA. Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial. BMC Health Serv Res 2019; 19:824. [PMID: 31711499 PMCID: PMC6849241 DOI: 10.1186/s12913-019-4529-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. Methods Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. Results The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). Conclusions The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken. Trial registration The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.
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Affiliation(s)
- Geerke Duijzer
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands. .,GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands.
| | - Andrea J Bukman
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - Aafke Meints-Groenveld
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands.,GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands.,Wageningen University, Consumption and Healthy Lifestyles, PO Box 8130, 6700 EW, Wageningen, the Netherlands
| | - Sophia C Jansen
- GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands
| | - Judith Heinrich
- GGD Noord- en Oost-Gelderland (Community Health Service), PO Box 3, 7200 AA, Warnsveld, the Netherlands
| | - Gerrit J Hiddink
- Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Social Sciences, Wageningen University, PO Box 8130, 6700 EW, Wageningen, the Netherlands
| | - Edith J M Feskens
- Wageningen University, Division of Human Nutrition; Academic Collaborative Centre AGORA, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Julius Centrum, PO Box 85500, STR 6.131, 3508 GA, Utrecht, the Netherlands.,Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands
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Tomasik T, Krzysztoń J, Dubas-Jakóbczyk K, Kijowska V, Windak A. The systematic coronary risk evaluation (SCORE) for the prevention of cardiovascular diseases. Does evidence exist for its effectiveness? A systematic review. Acta Cardiol 2017; 72:370-379. [PMID: 28705107 DOI: 10.1080/00015385.2017.1335052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The SCORE model predicts the ten-year risk of cardiovascular mortality but it is still unknown whether applying the SCORE in clinical practice subsequently improves cardiovascular disease (CVD) outcomes. The objective of this study is to assess the effect of total cardiovascular risk estimation using the SCORE in preventing serious cardiovascular events in European adults without prior CVD. METHODS AND RESULTS Data sources: eight bibliographical databases (2003 - August 2015), other internet sources and reference lists of articles were checked. This was supplemented by contact with the board members of the European Society of Cardiology (ESC) and the authors of the SCORE model. STUDY ELIGIBILITY CRITERIA all prospective studies in any language investigating the effect of using the SCORE on the clinical outcome (CVD death, major events and adverse outcomes) in an adult population were examined. Two reviewers assessed the studies independently (titles, abstracts, full texts). After removal of duplicates, 5,256 records were screened and 14 full text papers considered. No eligible studies were identified. An extensive literature search revealed no randomized control trial or other prospective study comparing significant clinical outcomes between groups that used the SCORE and those who did not. CONCLUSIONS The effect of using the SCORE (with or without subsequent intervention) on CVD death, all-cause mortality, major CVD events like myocardial infarction and stroke, as well as adverse outcomes, is still unknown. A cluster randomised controlled trial is warranted to evaluate the use of the SCORE on important outcomes.
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Affiliation(s)
- Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Janusz Krzysztoń
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Institute of Public Health, Chair of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Violetta Kijowska
- Unit for Research on Aging Society, Department of Sociology of Medicine at Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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Visscher TL, Lakerveld J, Olsen N, Küpers L, Ramalho S, Keaver L, Brei C, Bjune JI, Ezquerro S, Yumuk V. Perceived Health Status: Is Obesity Perceived as a Risk Factor and Disease? Obes Facts 2017; 10:52-60. [PMID: 28278496 PMCID: PMC5644964 DOI: 10.1159/000457958] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/12/2022] Open
Abstract
One might expect that a perception of obesity being a risk factor and disease, contributes to effective obesity prevention and management strategies. However, obesity rates continue to increase worldwide. The question arises whether obesity is truly perceived as a risk factor and a disease. This paper aims at describing perception of obesity as risk factor and disease among individuals seeking care, individuals not seeking care, the society, and different professionals having a role in the field of obesity. The paper is a reflection of the lecture on the topic that was given at the EASO's New Investigators United's Summer School 2016 in Portugal and the discussion with the new investigators and other senior speakers. Individual obese patients seeking help are very much aware of obesity being a risk factor and disease, but perceptions regarding obesity seem to be flawed among those who do not seek help for obesity. Also, misperceptions regarding obesity play a role at different levels, including society, different political levels, the fields of health care and social work, prevention organizations, and the food and marketing industry. The food and marketing industry has an enormous role in changing perceptions by the society and policy makers. Obesity rates will continue to increase as long as individuals, the society, and professionals at different levels have false interpretations of the severity of obesity. Severe action is needed against those who are playing a role in maintaining false perceptions of obesity as a risk factor and disease.
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Affiliation(s)
- Tommy L.S. Visscher
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- Research Centre for Healthy Cities, Windesheim University of Applied Sciences, Zwolle, The Netherlands, Istanbul, Turkey
- European Association for the Study of Obesity, Patient Council and Prevention and Public Health Taskforce, Founding Chair New Investigators United, London, UK, Istanbul, Turkey
| | - Jeroen Lakerveld
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands, Istanbul, Turkey
| | - Nanna Olsen
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Copenhagen, Denmark, Istanbul, Turkey
| | - Leanne Küpers
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, Istanbul, Turkey
| | - Sofia Ramalho
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- School of Psychology, University of Minho, Braga, Portugal, Istanbul, Turkey
| | - Laura Keaver
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- Department of Life Sciences, Institute of Technology Sligo, Sligo, Ireland, Istanbul, Turkey
| | - Christina Brei
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- Else Körner-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany, Istanbul, Turkey
| | - Jan-Inge Bjune
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway, Istanbul, Turkey
- Department of Clinical Science K2 and KG Jebsen Center for Diabetes Research, University of Bergen, Bergen, Norway, Istanbul, Turkey
| | - Silvia Ezquerro
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- Metabolic Research Laboratory, Clínica Universidad de Navarra, CIBEROBN, Pamplona, Spain, Istanbul, Turkey
| | - Volkan Yumuk
- European Association for the Study of Obesity, New Investigators United, London, UK, Istanbul, Turkey
- Istanbul University Cerrahpasa Medical Faculty, Division of Endocrinology, Metabolism and Diabetes, Istanbul, Turkey
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11
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Alouki K, Delisle H, Bermúdez-Tamayo C, Johri M. Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies. J Diabetes Res 2016; 2016:2159890. [PMID: 26885527 PMCID: PMC4738686 DOI: 10.1155/2016/2159890] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 01/29/2023] Open
Abstract
Objective. To summarize key findings of economic evaluations of lifestyle interventions for the primary prevention of type 2 diabetes (T2D) in high-risk subjects. Methods. We conducted a systematic review of peer-reviewed original studies published since January 2009 in English, French, and Spanish. Eligible studies were identified through relevant databases including PubMed, Medline, National Health Services Economic Evaluation, CINHAL, EconLit, Web of sciences, EMBASE, and the Latin American and Caribbean Health Sciences Literature. Studies targeting obesity were also included. Data were extracted using a standardized method. The BMJ checklist was used to assess study quality. The heterogeneity of lifestyle interventions precluded a meta-analysis. Results. Overall, 20 studies were retained, including six focusing on obesity control. Seven were conducted within trials and 13 using modeling techniques. T2D prevention by physical activity or diet or both proved cost-effective according to accepted thresholds, except for five inconclusive studies, three on diabetes prevention and two on obesity control. Most studies exhibited limitations in reporting results, primarily with regard to generalizability and justification of selected sensitivity parameters. Conclusion. This confirms that lifestyle interventions for the primary prevention of diabetes are cost-effective. Such interventions should be further promoted as sound investment in the fight against diabetes.
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Affiliation(s)
- Koffi Alouki
- TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1A8
| | - Hélène Delisle
- TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1A8
- *Hélène Delisle:
| | - Clara Bermúdez-Tamayo
- Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Avenue du Parc, 3e Étage, Montréal, QC, Canada H3N 1X9
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, 850 Rue Saint-Denis, Montréal, QC, Canada H2X 0A9
- Department of Health Administration, School of Public Health (ESPUM), Faculty of Medicine, University of Montreal, 7101 Avenue du Parc, 3e Étage, Montréal, QC, Canada H3N 1X9
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12
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Whitehurst DGT, Bryan S. Trial-based clinical and economic analyses: the unhelpful quest for conformity. Trials 2013; 14:421. [PMID: 24308301 PMCID: PMC4233716 DOI: 10.1186/1745-6215-14-421] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/21/2013] [Indexed: 11/17/2022] Open
Abstract
Where there is conformity across the findings, interpretation and implications of 'clinical’ and 'economic’ research, there is limited cause for concern. However, there is often unease when apparent contradictory conclusions are drawn from the same study. Given the ever increasing role for economic evaluation in healthcare decision making, this commentary challenges the necessity of compatibility between clinical and economic evaluation.
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Affiliation(s)
- David G T Whitehurst
- Faculty of Health Sciences, Blusson Hall 10504, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
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13
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Hesselink AE, Bilo HJG, Jonkers R, Martens M, de Weerdt I, Rutten GEH. A cluster-randomized controlled trial to study the effectiveness of a protocol-based lifestyle program to prevent type 2 diabetes in people with impaired fasting glucose. BMC FAMILY PRACTICE 2013; 14:184. [PMID: 24295397 PMCID: PMC4219396 DOI: 10.1186/1471-2296-14-184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/19/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Effective diabetes prevention strategies that can be implemented in daily practice, without huge amounts of money and a lot of personnel are needed. The Dutch Diabetes Federation developed a protocol for coaching people with impaired fasting glucose (IFG; according to WHO criteria: 6.1 to 6.9 mmol/l) to a sustainable healthy lifestyle change: 'the road map towards diabetes prevention' (abbreviated: Road Map: RM). This protocol is applied within a primary health care setting by a general practitioner and a practice nurse. The feasibility and (cost-) effectiveness of care provided according to the RM protocol will be evaluated. METHODS/DESIGN A cluster randomised clinical trial is performed, with randomisation at the level of the general practices. Both opportunistic screening and active case finding took place among clients with high risk factors for diabetes. After IFG is diagnosed, motivated people in the intervention practices receive 3-4 consultations by the practice nurse within one year. During these consultations they are coached to increase the level of physical activity and healthy dietary habits. If necessary, participants are referred to a dietician, physiotherapist, lifestyle programs and/or local sports activities. The control group receives care as usual. The primary outcome measure in this study is change in Body Mass Index (BMI). Secondary outcome measures are waist circumference, physical activity, total and saturated fat intake, systolic blood pressure, blood glucose, total cholesterol, HDL cholesterol, triglycerides and behaviour determinants like risk perception, perceived knowledge and motivation. Based on a sample size calculation 120 people in each group are needed. Measurements are performed at baseline, and after one (post-intervention) and two years follow up. Anthropometrics and biochemical parameters are assessed in the practices and physical activity, food intake and their determinants by a validated questionnaire. The cost-effectiveness is estimated by using the Chronic Disease Model (CDM). Feasibility will be tested by interviews among health care professionals. DISCUSSION The results of the study will provide valuable information for both health care professionals and policy makers. If this study shows the RM to be both effective and cost-effective the protocol can be implemented on a large scale. TRIAL REGISTRATION ISRCTN41209683. Ethical approval number: NL31342.075.10.
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Affiliation(s)
| | - Henk JG Bilo
- Diabetes Centre, Isala clinics and Department of Internal Medicine, Isala Clinics, Zwolle; and, University Medical Centre Groningen, Groningen, Netherlands
| | - Ruud Jonkers
- ResCon, Research & Consultancy, Haarlem, Netherlands
| | | | | | - Guy EH Rutten
- Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
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Lakerveld J, Bot SDM, van der Ploeg HP, Nijpels G. The effects of a lifestyle intervention on leisure-time sedentary behaviors in adults at risk: the Hoorn Prevention Study, a randomized controlled trial. Prev Med 2013; 57:351-6. [PMID: 23777672 DOI: 10.1016/j.ypmed.2013.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 06/05/2013] [Accepted: 06/09/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study set out to assess the short- and long-term effects of a primary care-based lifestyle intervention on different domains of leisure-time sedentary behaviors in Dutch adults at risk of type 2 diabetes and cardiovascular diseases. METHODS Between 2007 and 2009, adults (n=622) at risk were randomly assigned to a counseling intervention aimed at adopting healthy lifestyle behaviors, or a control group that only received health brochures. Follow-up measures were done after 6, 12 and 24months. Linear regression analysis was used to examine between-group differences in self-report minutes per day sedentary behaviors, adjusted for baseline values. Stratified analyses were performed for sex and educational attainment. RESULTS Seventy-nine percent (n=490) of participants completed the last follow-up. Mean baseline sedentary behaviors were 254.6min per day (SD=136.2). Intention-to-treat analyses showed no significant differences in overall or domain-specific sedentary behaviors between the two groups at follow-up. Stratified analyses for educational attainment revealed a small and temporary between-group difference in favor of the intervention group, in those who finished secondary school. CONCLUSIONS A primary care-based general lifestyle intervention was not more effective in reducing leisure-time sedentary behaviors than providing brochures in adults at risk for chronic diseases.
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Affiliation(s)
- Jeroen Lakerveld
- Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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