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Quality of life and cost-effectiveness of a 3-year trial of lifestyle intervention in primary health care
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Departement of Social medicine and Public Health and centre for Health Care Science Örebro County Council.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0002-1633-2179
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
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2010 (English)In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 170, no 16, 1470-1479 p.Article in journal (Refereed) Published
Abstract [en]

Background: Lifestyle interventions reduce cardiovascular risk and diabetes but reports on long term effects on quality of life (QOL) and health care utilization are rare. The aim was to investigate the impact of a primary health care based lifestyle intervention program on QOL and cost-effectiveness over 3 years.

Methods: 151 men and women, age 18-65 yr, at moderate-to-high risk for cardiovascular disease, were randomly assigned to either lifestyle intervention with standard care or standard care alone. Intervention consisted of supervised exercise sessions and diet counseling for 3 months, followed by regular group meetings during 3years. Change in QOL was measured with EuroQol (EQ-5D, EQ VAS), the 36-item Short Form Health Survey (SF-36), and the SF-6D.  The health economic evaluation was performed from a societal view and a treatment perspective. In a cost-utility analysis the costs, gained quality-adjusted life years (QALY) and savings in health care were considered. Cost-effectiveness was also described using the Net Monetary Benefit Method.

Results: Significant differences between groups over the 3-yr period were shown in EQ VAS, SF-6D and SF-36 physical component summary but not in EQ-5D or SF-36 mental component summary. There was a net saving of 47 USD per participant. Costs per gained QALY, savings not counted, were 1,668 – 4,813 USD. Probabilities of cost-effectiveness were 89 – 100 %, when 50 000 USD was used as stakeholder’s threshold of willingness to pay for a gained QALY.

Conclusion: Lifestyle intervention in primary care improves QOL and is highly cost-effective in relation to standard care.

Place, publisher, year, edition, pages
Chicago: American Medical Association , 2010. Vol. 170, no 16, 1470-1479 p.
Keyword [en]
randomized controlled trial, physical activity, body mass, women, prescription, utilities, exercise, efficacy, program, Sweden
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-32764DOI: 10.1001/archinternmed.2010.301ISI: 000281764100009OAI: oai:DiVA.org:umu-32764DiVA: diva2:305702
Available from: 2010-03-25 Created: 2010-03-25 Last updated: 2017-12-12Bibliographically approved
In thesis
1. A 3-year lifestyle intervention in primary health care: effects on physical activity, cardiovascular risk factors, quality of life and cost-effectiveness
Open this publication in new window or tab >>A 3-year lifestyle intervention in primary health care: effects on physical activity, cardiovascular risk factors, quality of life and cost-effectiveness
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: A sedentary lifestyle diminishes quality of life (QOL) and contributes to increasing prevalence of obesity, diabetes and cardiovascular diseases (CVD), and thus increases the economic burden on health care and society. Expensive and tightly controlled lifestyle interventions reduce cardiovascular risk and onset of diabetes. Transferring these findings to the primary care setting is of clinical importance. The primary aim of this thesis was to apply a lifestyle intervention program in the primary care setting among individuals with moderate-to-high risk for CVD, and evaluate the effects on physical activity, cardiovascular risk factor levels and QOL. A secondary aim was to investigate the cost-effectiveness.

Methods: A randomized controlled trial with one intervention group (n=75) and one control group (n=76) with follow-up at 3, 12, 24 and 36 months was used. Patients with the diagnosis obesity, hypertension, dyslipidemia, type 2 diabetes or any combination thereof (mean age 54 yr, 57% female) were recruited from a primary health centre in northern Sweden. The three-month intervention period consisted of group-based supervised exercise sessions and diet counselling, followed by regular, but sparse, group meetings with a behavioural approach during three years. Clinical measurements included anthropometrics, aerobic fitness, blood pressure and metabolic traits. Questionnaires on self-reported physical activity, stages of change for physical activity, and QOL were used. In a cost-utility analysis the costs, gained quality-adjusted life years (QALY), and savings in health care were considered. Probability of cost-effectiveness was described using Net Monetary Benefit Method.

Results: Overall, the lifestyle intervention generated beneficial improvements in anthropometrics, blood pressure, aerobic fitness and activity level, and QOL, compared to the control group which only received one information meeting.  At 36 months, intention-to-treat analyses showed that lifestyle modification reduced waist circumference (–2.2 cm), waist-hip ratio (–0.02), systolic blood pressure (–5.1 mmHg), and diastolic blood pressure (–1.6 mmHg) and significantly improved aerobic fitness (5%).  BMI, lipid or glucose values did not differ between groups. Progression to active stages of change for physical activity and increases in time spent exercising and total physical activity were reported. Both physical and mental dimensions of QOL were improved during the study period, but after 3 years differences persisted mainly in physical dimensions. Cost per gained QALY was low, 1668-4813 USD (savings not counted). Visits to family physicians significantly decreased and there was a net saving of 47 USD per participant. Probabilities of cost-effectiveness were 89-100% when 50 000 USD was used as threshold of willingness to pay for a gained QALY.

Conclusions: A group-based lifestyle intervention program in a primary health care setting favourably influences cardiovascular risk-factor profiles, increases physical activity level, and improves several dimensions of QOL in high-risk individuals, at least up to 3 years. The intervention method was highly cost-effective in relation to standard care. The results emphasize the advantage of an intervention that combines supervised exercise with regular follow-ups for reaching long term effects.  The study high-lights the feasibility of lifestyle interventions in the primary care setting and the importance of health care professionals supporting change in lifestyle.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2010. 117 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1333
Keyword
lifestyle intervention, primary health care, physical activity, cardiovascular risk factors, quality of life, cost-effectivenesss
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-32765 (URN)978-91-7264-953-8 (ISBN)
Public defence
2010-04-16, Aulan, konferenscenter, Sunderby sjukhus, Luleå, 13:00 (English)
Opponent
Supervisors
Available from: 2010-03-26 Created: 2010-03-25 Last updated: 2010-09-27Bibliographically approved

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