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. Rissanen, Elisa & Karjalainen, Piia & Kiviruusu, Olli & Kankaanpää, Eila & Aronen, Eeva T. & Haula, Taru & Sääksvuori, Lauri & Vornanen, Riitta & Linnosmaa, Ismo, 2024. "Cost-effectiveness of a parenting program to reduce children’s behavioral problems among families receiving child protection services and other family support services – A randomized controlled trial," Children and Youth Services Review, Elsevier, vol. 158(C).
    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. 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.
    7. 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.
    8. 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.
    9. 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.
    10. Benjamin Thorpe & Orlagh Carroll & Linda Sharples, 2018. "Methods for Handling Unobserved Covariates in a Bayesian Update of a Cost-effectiveness Model," Medical Decision Making, , vol. 38(2), pages 150-162, February.
    11. Ilias Goranitis & Leana Bellanca & Amanda J Daley & Adele Thomas & Helen Stokes-Lampard & Andrea K Roalfe & Sue Jowett, 2017. "Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-15, September.
    12. Jackie, Yenerall & Wen, You & George, Davis & Paul, Estabrooks, 2015. "Examining Ways to Handle Non-Random Missingness in CEA through Econometric and Statistics Lenses," 2015 AAEA & WAEA Joint Annual Meeting, July 26-28, San Francisco, California 205690, Agricultural and Applied Economics Association.
    13. Adriano Zanin Zambom & Gregory J. Matthews, 2021. "Sure independence screening in the presence of missing data," Statistical Papers, Springer, vol. 62(2), pages 817-845, April.
    14. Sander M. Brink & Heleen M. Wortelboer & Cornelis H. Emmelot & Tommy L. S. Visscher & Herman A. van Wietmarschen, 2022. "Developing a Personalized Integrative Obesity-Coaching Program: A Systems Health Perspective," IJERPH, MDPI, vol. 19(2), pages 1-13, January.
    15. David Glynn & John Giardina & Julia Hatamyar & Ankur Pandya & Marta Soares & Noemi Kreif, 2024. "Integrating decision modeling and machine learning to inform treatment stratification," Health Economics, John Wiley & Sons, Ltd., vol. 33(8), pages 1772-1792, August.
    16. Alexina J. Mason & Manuel Gomes & Richard Grieve & James R. Carpenter, 2018. "A Bayesian framework for health economic evaluation in studies with missing data," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1670-1683, November.
    17. 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.
    18. Geke Romijn & Neeltje Batelaan & Jeroen Koning & Anton van Balkom & Aart de Leeuw & Friederike Benning & Leona Hakkaart van Roijen & Heleen Riper, 2021. "Acceptability, effectiveness and cost-effectiveness of blended cognitive-behavioural therapy (bCBT) versus face-to-face CBT (ftfCBT) for anxiety disorders in specialised mental health care: A 15-week ," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-20, November.
    19. Ansam Barakat & Jurgen E. Cornelis & Jack J. M. Dekker & Nick M. Lommerse & Aartjan T. F. Beekman & Matthijs Blankers, 2025. "Economic evaluation of intensive home treatment in comparison to care as usual alongside a randomised controlled trial," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(1), pages 23-34, February.
    20. 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.

    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.