An economic evaluation alongside a randomized controlled trial evaluating an individually tailored lifestyle intervention compared with usual care in people with Familial Hypercholesterolemia

BMC Research Notes

Mireille N M van Poppel¹  Judith E Bosmans⁴  Willem van Mechelen¹  Johannes Brug³  Lando L J Koppes²  Marieke F van Wier⁴  Karen Broekhuizen¹ 

[1] Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands;TNO, Division Work and Employment, Hoofddorp, The Netherlands;Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands;Department of Health Economics and Health Technology Assessment, Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University, Amsterdam, The Netherlands

关键词: Sedentary lifestyle;    Cholesterol;    Cardiovascular disease;    Counselling;    Cost-benefit analysis;   

Others  :  1230937
DOI  :  10.1186/s13104-015-1282-x

 received in 2015-02-05, accepted in 2015-07-16,  发布年份 2015

【 摘 要 】

Background

Cost-effectiveness analyses provide insight in the use of lifestyle interventions. To evaluate the cost-effectiveness of a lifestyle intervention compared to usual care in people with Familial Hypercholesterolemia, 340 people with FH were randomized to the intervention or control group. LDL cholesterol, quality of life and costs were measured at 0 and 12 months. Cost-effectiveness analyses were performed from a healthcare perspective using bootstrapping techniques.

Results

Non-significant decreases in LDL cholesterol and quality of life were found. The mean between-group difference in costs was €−237 (95% CI −1,386 to 130). The incremental cost-effectiveness ratios were 1,729 per 1 mmol/l LDL cholesterol and 145,899 per QALY gained. Assumed that the small non-significant decrease in LDL cholesterol is attributed to the intervention, the probability of cost-effectiveness of the intervention compared to usual care was 91% per 1 mmol/l LDL cholesterol reduction and 75% per QALY gained at a ceiling ratio of €20,000.

Conclusions

The intervention is not cost-effective.

Trial registration: NTR1899, date 07-07-2009.

【 授权许可】

   
2015 Broekhuizen et al.

【 图 表 】

Fig.1.

Fig.2.

Fig.3.

Fig.1.

Fig.2.

Fig.3.

【 参考文献 】

• [1]Goldstein J, Hobbs H, Brown M: Familial hypercholesterolemia. In The metabolic and molecular bases of inherited disease. Edited by Scriver C, Beaudet A, Sly WS, Valle D. McGraw-Hill, New York (NY); 2001:2863-2913.
• [2]Fauci AS, Braunwald E, Kasper DL, Hauser SL, Jameson JL, Loscalzo J: Harrison’s principles of internal medicine. 17th edition. McGraw-Hill Medical Publishing Division, New York (NY); 2008.
• [3]Scientific Steering Committee on behalf of the Simon Broome Register Group: Risk of fatal coronary heart disease in familial hypercholesterolaemia BMJ 1991, 303:893-896.
• [4]Stichting Opsporing Erfelijke Hypercholesterolemie StOEH (Foundation for Tracing Hereditary Hypercholesterolemia) (2010) Annual Report 2009, StOEH, 2010, Amsterdam, the Netherlands
• [5]Guilbert JJ: The world health report 2. Educ Health 2003, 16:230.
• [6]Allender S, Scarborough P, Peto V, Rayner M: European cardiovascular statistics. European Heart Network, Brussels; 2008.
• [7]Blokstra A, van Dis I, Verschuren WM: Efficacy of multifactorial lifestyle interventions in patients with established cardiovascular diseases and high risk groups. Eur J Cardiovasc Nurs 2010, 11:97-104.
• [8]Kromhout D, Menotti A, Kesteloot H, Sans S: Prevention of coronary heart disease by diet and lifestyle: evidence from prospective cross-cultural, cohort, and intervention studies. Circulation 2002, 105:893-898.
• [9]Lin JS, O’Connor E, Evans CV, Senger CA, Rowland MG, Groom HC: Behavioral counseling to promote a healthy lifestyle in persons with cardiovascular risk factors: a systematic review for the US Preventive Services Task Force. Ann Intern Med 2014, 161(8):568-578.
• [10]Broekhuizen K, van Poppel MNM, Koppes LL, Brug J, van Mechelen W: A tailored lifestyle intervention to reduce the cardiovascular disease risk of individuals with Familial Hypercholesterolemia: design of the PRO-FIT randomised controlled trial. BMC Public Health 2010, 10:69. BioMed Central Full Text
• [11]Rubak S, Sandbaek A, Lauritzen T, Christensen B: Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005, 55:305-312.
• [12]Brooks R: EuroQol: the current state of play. Health Policy 1996, 37:53-72.
• [13]Lamers LM, Stalmeier PF, McDonnell J, Krabbe PF, van Busschbach JJ: Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff. Ned Tijdschr Geneeskd 2005, 149:1574-1578.
• [14]Statistics Netherlands (2012) Prices, consumer prices. http://statline.cbs.nl. Accessability verified May 21, 2012
• [15]Oostenbrink J, Bouwmans CKM, Rutten F (2004) Handleiding voor kostenonderzoek: Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Dutch Health Care Insurance Board, Diemen, the Netherlands
• [16]Royal Dutch Society for pharmacy (2006) Z-index. G-standard, The Hague, The Netherlands
• [17]Azur MJ, Stuart EA, Frangakis C, Leaf PJ: Multiple imputation by chained equations: what is it and how does it work? Int J Methods Psychiatr Res 2011, 20:40-49.
• [18]van Buuren S: Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 2007, 16:219-242.
• [19]National Institute for Health and Clinical Excellence: Guide to the methods of technology appraisal. NICE, London; 2004.
• [20]Rubin D: Multiple imputation for nonresponse in surveys. Wiley, New York (NY); 1987.
• [21]Burton A, Billingham LJ, Bryan S: Cost-effectiveness in clinical trials: using multiple imputation to deal with incomplete cost data. Clin Trials 2007, 4:154-161.
• [22]R Development Core Team (2008) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria
• [23]Saha S, Gerdtham UG, Johansson P: Economic evaluation of lifestyle interventions for preventing diabetes and cardiovascular diseases. Int J Environ Res Public Health 2010, 7:3150-3195.
• [24]Nherera L, Calvert NW, Demott K, Humphries SE, Neil HA, Minhas R, et al.: Cost-effectiveness analysis of the use of a high-intensity statin compared to a low-intensity statin in the management of patients with familial hypercholesterolaemia. Curr Med Res Opin 2010, 26:529-536.
• [25]Van Dongen JM, Proper KI, van Wier MF, van der Beek AJ, Bongers PM, van Mechelen W, et al.: A systematic review on the cost-effectiveness of worksite physical activity and/or nutrition programs. Scand J Work Environ Health 2012, 38:393-408.
• [26]Bell CM, Urbach DR, Ray JG, Bayoumi A, Rosen A: Bias in published cost-effectiveness studies: a systematic review. BMJ 2006, 332:699-703.
• [27]Petrou S, Gray A: Economic evaluation alongside randomised controlled trials: design, conduct, analysis, and reporting. BMJ 2011, 342:1548.
• [28]Schafer JL, Graham JW: Missing data: our view of the state of the art. Psychol Methods 2002, 7:147-177.