IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v20y2023i6p5040-d1095515.html
   My bibliography  Save this article

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

Author

Listed:
  • 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)

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.

Suggested Citation

  • Emma A. Nieuwenhuijse & Rimke C. Vos & Wilbert B. van den Hout & Jeroen N. Struijs & Sanne M. Verkleij & Karin Busch & Mattijs E. Numans & Tobias N. Bonten, 2023. "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," IJERPH, MDPI, vol. 20(6), pages 1-17, March.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:6:p:5040-:d:1095515
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/20/6/5040/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/20/6/5040/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Celeste Van Rinsum & Sanne Gerards & Geert Rutten & Nicole Philippens & Ester Janssen & Bjorn Winkens & Ien Van de Goor & Stef Kremers, 2018. "The Coaching on Lifestyle (CooL) Intervention for Overweight and Obesity: A Longitudinal Study into Participants’ Lifestyle Changes," IJERPH, MDPI, vol. 15(4), pages 1-27, April.
    2. Rita Faria & Manuel Gomes & David Epstein & Ian White, 2014. "A Guide to Handling Missing Data in Cost-Effectiveness Analysis Conducted Within Randomised Controlled Trials," PharmacoEconomics, Springer, vol. 32(12), pages 1157-1170, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Andrea Gabrio & Catrin Plumpton & Sube Banerjee & Baptiste Leurent, 2022. "Linear mixed models to handle missing at random data in trial‐based economic evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1276-1287, June.
    2. Abualbishr Alshreef & Allan J. Wailoo & Steven R. Brown & James P. Tiernan & Angus J. M. Watson & Katie Biggs & Mike Bradburn & Daniel Hind, 2017. "Cost-Effectiveness of Haemorrhoidal Artery Ligation versus Rubber Band Ligation for the Treatment of Grade II–III Haemorrhoids: Analysis Using Evidence from the HubBLe Trial," PharmacoEconomics - Open, Springer, vol. 1(3), pages 175-184, September.
    3. Sun Sun & Nan Luo & Erik Stenberg & Lars Lindholm & Klas-Göran Sahlén & Karl A. Franklin & Yang Cao, 2022. "Sequential Multiple Imputation for Real-World Health-Related Quality of Life Missing Data after Bariatric Surgery," IJERPH, MDPI, vol. 19(17), pages 1-16, August.
    4. Janet MacNeil Vroomen & Iris Eekhout & Marcel G. Dijkgraaf & Hein van Hout & Sophia E. de Rooij & Martijn W. Heymans & Judith E. Bosmans, 2016. "Multiple imputation strategies for zero-inflated cost data in economic evaluations: which method works best?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(8), pages 939-950, November.
    5. Laura Pirhonen & Kristian Bolin & Elisabeth Hansson Olofsson & Andreas Fors & Inger Ekman & Karl Swedberg & Hanna Gyllensten, 2019. "Person-Centred Care in Patients with Acute Coronary Syndrome: Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial," PharmacoEconomics - Open, Springer, vol. 3(4), pages 495-504, December.
    6. Janet MacNeil Vroomen & Judith E Bosmans & Iris Eekhout & Karlijn J Joling & Lisa D van Mierlo & Franka J M Meiland & Hein P J van Hout & Sophia E de Rooij, 2016. "The Cost-Effectiveness of Two Forms of Case Management Compared to a Control Group for Persons with Dementia and Their Informal Caregivers from a Societal Perspective," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-20, September.
    7. Baptiste Leurent & Manuel Gomes & James R. Carpenter, 2018. "Missing data in trial‐based cost‐effectiveness analysis: An incomplete journey," Health Economics, John Wiley & Sons, Ltd., vol. 27(6), pages 1024-1040, June.
    8. Jacqueline J Suijker & Janet L MacNeil-Vroomen & Marjon van Rijn & Bianca M Buurman & Sophia E de Rooij & Eric P Moll van Charante & Judith E Bosmans, 2017. "Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-16, April.
    9. William Hollingworth & Christopher G. Fawsitt & Padraig Dixon & Larisa Duffy & Ricardo Araya & Tim J. Peters & Howard Thom & Nicky J. Welton & Nicola Wiles & Glyn Lewis, 2020. "Cost-Effectiveness of Sertraline in Primary Care According to Initial Severity and Duration of Depressive Symptoms: Findings from the PANDA RCT," PharmacoEconomics - Open, Springer, vol. 4(3), pages 427-438, September.
    10. Nicole Philippens & Ester Janssen & Sacha Verjans-Janssen & Stef Kremers & Rik Crutzen, 2021. "HealthyLIFE, a Combined Lifestyle Intervention for Overweight and Obese Adults: A Descriptive Case Series Study," IJERPH, MDPI, vol. 18(22), pages 1-15, November.
    11. Deidda, Manuela & Geue, Claudia & Kreif, Noemi & Dundas, Ruth & McIntosh, Emma, 2019. "A framework for conducting economic evaluations alongside natural experiments," Social Science & Medicine, Elsevier, vol. 220(C), pages 353-361.
    12. Ângela Jornada Ben & Johanna M. Dongen & Mohamed El Alili & Martijn W. Heymans & Jos W. R. Twisk & Janet L. MacNeil-Vroomen & Maartje Wit & Susan E. M. Dijk & Teddy Oosterhuis & Judith E. Bosmans, 2023. "The handling of missing data in trial-based economic evaluations: should data be multiply imputed prior to longitudinal linear mixed-model analyses?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(6), pages 951-965, August.
    13. Victoria K. Brennan & Georgina Jones & Stephen Radley & Simon Dixon, 2021. "Incorporating Process Utility into Cost-Effectiveness Analysis via a Bolt-On Domain to the SF-6D: An Exploratory Study," Applied Health Economics and Health Policy, Springer, vol. 19(5), pages 747-756, September.
    14. Helen A. Dakin & José Leal & Andrew Briggs & Philip Clarke & Rury R. Holman & Alastair Gray, 2020. "Accurately Reflecting Uncertainty When Using Patient-Level Simulation Models to Extrapolate Clinical Trial Data," Medical Decision Making, , vol. 40(4), pages 460-473, May.
    15. Becky Pennington & Abualbishr Alshreef & Laura Flight & Andrew Metry & Edith Poku & Philip Hykin & Sobha Sivaprasad & A. Toby Prevost & Joana C. Vasconcelos & Caroline Murphy & Joanna Kelly & Yit Yang, 2021. "Cost Effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the Treatment of Macular Oedema Due to Central Retinal Vein Occlusion: The LEAVO Study," PharmacoEconomics, Springer, vol. 39(8), pages 913-927, August.
    16. Alexina J. Mason & Manuel Gomes & James Carpenter & Richard Grieve, 2021. "Flexible Bayesian longitudinal models for cost‐effectiveness analyses with informative missing data," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 3138-3158, December.
    17. Padraig Dixon & William Hollingworth & Jonathan Benger & James Calvert & Melanie Chalder & Anna King & Stephanie MacNeill & Katherine Morton & Emily Sanderson & Sarah Purdy, 2020. "Observational Cost-Effectiveness Analysis Using Routine Data: Admission and Discharge Care Bundles for Patients with Chronic Obstructive Pulmonary Disease," PharmacoEconomics - Open, Springer, vol. 4(4), pages 657-667, December.
    18. Baptiste Leurent & Manuel Gomes & Rita Faria & Stephen Morris & Richard Grieve & James R. Carpenter, 2018. "Sensitivity Analysis for Not-at-Random Missing Data in Trial-Based Cost-Effectiveness Analysis: A Tutorial," PharmacoEconomics, Springer, vol. 36(8), pages 889-901, August.
    19. Andrea Gabrio & Alexina J. Mason & Gianluca Baio, 2017. "Handling Missing Data in Within-Trial Cost-Effectiveness Analysis: A Review with Future Recommendations," PharmacoEconomics - Open, Springer, vol. 1(2), pages 79-97, June.
    20. Mohamed El Alili & Johanna M. van Dongen & Jonas L. Esser & Martijn W. Heymans & Maurits W. van Tulder & Judith E. Bosmans, 2022. "A scoping review of statistical methods for trial‐based economic evaluations: The current state of play," Health Economics, John Wiley & Sons, Ltd., vol. 31(12), pages 2680-2699, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:20:y:2023:i:6:p:5040-:d:1095515. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.