Cost-utility of a cardiovascular prevention programme in highly educated adults: a randomised controlled trial

Abstract

Objectives. Little is known about the costs and the effects of cardiovascular prevention programmes that are targeted at medical and behavioural risk factors and use computer tailoring. Methods. A general sample of 314 highly educated adults was recruited in Belgium and included in a randomised controlled trial of an intensive intervention and a standard intervention. Participants in the intensive intervention condition received medical assessments and could choose for behaviour change interventions (access to a tailored website, individual coaching and group sessions). Participants in the standard intervention condition received medical assessments for data collection. The latter condition was comparable to a preventive consultation in general practice following the guidelines. Cost data were registered from a health care perspective and the Short-Form 36© (SF-36), the International Physical Activity Questionnaire (IPAQ) and a validated fat intake questionnaire were used to measure effectiveness. Outcome measures were costs, quality adjusted life years (QALYs), the Incremental Cost-Effectiveness Ratio (ICER) and behaviour change. Non-parametric bootstrap analysis and sensitivity analyses were performed. Results. Of the participants, 219 completed the questionnaires at baseline, at 6 months and after one year. The ICER was €80.421/QALY when including the developmental costs of the intensive intervention. The incremental cost of the intensive intervention was €433 and the incremental effectiveness was 0,005 QALYs. The majority (69%) of the cost-effect pairs after bootstrap analysis were located in the northeast quadrant, suggesting more effect but at higher costs. Nevertheless, 31% of the cost-effect pairs were located in the northwest quadrant, suggesting higher costs without additional effect. Without the developmental costs of the intensive intervention, the ICER dropped to €21.055/QALY. For intensive physical activity and fat intake, however, 83% and 89% and of the cost-effect pairs were located in the northeast quadrant. Conclusions. The intensive intervention was not cost-effective compared to a standard intervention in a general sample of highly educated adults after one year of intervention. Perhaps cardiovascular prevention programmes cannot result in large QALY differences in healthy people on the short-term. Further research is needed to determine the cost-utility of this intervention for different target groups on the long-term.