Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study)

International Journal of Behavioral Nutrition and Physical Activity

Tomàs López-Jiménez¹  Edurne Zabaleta-Del-Olmo²  Ruth Martí-Lluch³  Bonaventura Bolíbar⁴  Marc Casajuana-Closas⁴  Rosa Magallón-Botaya⁵  Juan Bellón⁶  Emma Motrico⁷  Haizea Pombo-Ramos⁸  Oana Bulilete⁹  Jose Ángel Maderuelo-Fernández^1,10  Elizabeth Parody-Rúa^1,11  Antoni Serrano-Blanco^1,12  Maria Rubio-Valera^1,12  Alba Sánchez-Viñas^1,12  Ignacio Aznar-Lou^1,12  Montserrat Iracheta-Todó^1,13  María Victoria Martín Miguel^1,14 

[1] Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain;Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain;Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain;Departament d’Infermeria, Facultat d’Infermeria, Universitat de Girona, Girona, Spain;Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain;Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain;ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Girona, Catalonia, Spain;Biomedical Research Institute, Girona (IdIBGi), ICS, Girona, Catalonia, Spain;Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain;Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain;IIS-Aragón Grupo b21-17R, Universidad de Zaragoza, Zaragoza, Spain;CS Arrabal.Servicio Aragonés de Salud, Zaragoza, Spain;Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain;Centro de Salud El Palo, Málaga, Spain;Department of Preventive Medicine, University of Málaga, Málaga, Spain;Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain;Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain;Universidad Loyola Andalucía, Sevilla, Spain;Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Bilbao, Spain;Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain;Primary Care Research Unit, Mallorca, Balearic Public Health Service, Palma de Mallorca, Spain;Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain;Primary Health Care Research Unit of Salamanca (APISAL), Health Service of Castilla y León (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain;Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain;Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain;Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain;Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain;Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain;Vigo Primary Health Care, Vigo, Spain;I-Saúde Research Group (IISGS), Vigo, Spain;

关键词: Economic evaluation;    Health promotion;    Primary care;    Hybrid trial;   

DOI  :  10.1186/s12966-021-01144-5

来源: Springer

【 摘 要 】

BackgroundMultiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction.MethodsAn economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results.ResultsThe study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (− 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis.ConclusionThe efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects.Trial registrationClinicaltrials.gov NCT03136211. Registered 02 May 2017 – Retrospectively registered

【 授权许可】

CC BY