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Open Access Highly Accessed Research article

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

Marieke F van Wier15*, Jeroen Lakerveld2, Sandra D M Bot2, Mai J M Chinapaw3, Giel Nijpels2 and Maurits W van Tulder14

Author affiliations

1 Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

2 Departments of General Practice and Elderly Care and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

3 Departments of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

4 Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands

5 Faculty of Earth and Life Sciences, Department of Health Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands

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Citation and License

BMC Family Practice 2013, 14:45  doi:10.1186/1471-2296-14-45

Published: 4 April 2013

Abstract

Background

Cost-effectiveness studies of lifestyle interventions in people at risk for lifestyle-related diseases, addressing ‘real-world’ implementation, are needed. This study examines the cost-effectiveness of a primary care intervention from a societal perspective, compared with provision of health brochures, alongside a randomized controlled trial.

Methods

Adults aged 30-50 years, at risk of type 2 diabetes (T2DM) and/or cardiovascular disease (CVD), were recruited from twelve general practices in The Netherlands. They were randomized to the intervention (n = 314) or control group (n = 308). The intervention consisted of up to six face-to-face counseling sessions with a trained practice nurse, followed by three-monthly sessions by phone. Costs were collected using three-monthly retrospective questionnaires. Quality of life was measured with the EuroQol-5D-3L, at baseline, 6, 12 and 24 months. Nine-year risk of developing T2DM and ten-year risk of CVD mortality were estimated using the ARIC and SCORE formulae, respectively, based on measurements at baseline and 24 months while applying a fixed age of 60 years at both time points.

Results

Small, statistically non-significant differences in effects were found between the intervention and control group with regard to risk scores and Quality Adjusted Life Years (QALYs) gained. The mean difference in costs between the intervention and control group was €-866 (95% confidence interval -2372; 370). The probability that the intervention was cost-effective varied from 93% at €8000/QALY to 88% at €80,000/QALY.

Conclusion

A primary care lifestyle intervention aimed at adults at increased risk of T2DM and/or CVD could result in cost savings over a two-year period. However, due to methodological uncertainty no advice can be given regarding the implementation of the intervention in Dutch general practices.

Trial registration

Current Controlled Trials ISRCTN59358434.

Keywords:
Cost-effectiveness; Cost-utility; General practitioner; Lifestyle counseling; Practice nurse