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Cost-effectiveness of lifestyle modification in diabetic patients.

Jacobs-van der Bruggen MA, van Baal PH, Hoogenveen RT, Feenstra TL, Briggs AH, Lawson K, Feskens EJ, Baan CA - Diabetes Care (2009)

Bottom Line: A self-management education program (X-PERT) and physical activity counseling achieved the best results with > or =0.10 QALYs gained and > or =99% probability to be very cost-effective (< or =euro20,000/QALY).However, essential evidence for long-term maintenance of health benefits was limited.Future research should be focused on long-term effectiveness and multiple treatment strategies should be compared to determine incremental costs and benefits of one over the other.

View Article: PubMed Central - PubMed

Affiliation: Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. monique.jacobs@rivm.nl

ABSTRACT
OBJECTIVE To explore the potential long-term health and economic consequences of lifestyle interventions for diabetic patients. RESEARCH DESIGN AND METHODS A literature search was performed to identify interventions for diabetic patients in which lifestyle issues were addressed. We selected recent (2003-2008), randomized controlled trials with a minimum follow-up of 12 months. The long-term outcomes for these interventions, if implemented in the Dutch diabetic population, were simulated with a computer-based model. Costs and effects were discounted at, respectively, 4 and 1.5% annually. A lifelong time horizon was applied. Probabilistic sensitivity analyses were performed, taking account of variability in intervention costs and (long-term) treatment effects. RESULTS Seven trials with 147-5,145 participants met our predefined criteria. All interventions improved cardiovascular risk factors at > or =1 year follow-up and were projected to reduce cardiovascular morbidity over lifetime. The interventions resulted in an average gain of 0.01-0.14 quality-adjusted life-years (QALYs) per participant. Health benefits were generally achieved at reasonable costs (< or =euro50,000/QALY). A self-management education program (X-PERT) and physical activity counseling achieved the best results with > or =0.10 QALYs gained and > or =99% probability to be very cost-effective (< or =euro20,000/QALY). CONCLUSIONS Implementation of lifestyle interventions would probably yield important health benefits at reasonable costs. However, essential evidence for long-term maintenance of health benefits was limited. Future research should be focused on long-term effectiveness and multiple treatment strategies should be compared to determine incremental costs and benefits of one over the other.

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Cost-effectiveness acceptability curves for each intervention.
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Figure 1: Cost-effectiveness acceptability curves for each intervention.

Mentions: As expected, assuming 100% correlation between risk factor outcomes increased the variability of the simulated outcomes (supplementary Table A10, available in an online appendix). For example, for Look AHEAD, QALYs increased by 0.03–0.12 if outcomes were assumed to be independent and by 0.01–0.15 with 100% correlation. Similarly, the variability in simulated health care costs and CERs was higher if outcomes were assumed to be correlated (data not shown). The cost-effectiveness acceptability curves for the interventions, assuming correlated outcomes, are displayed in Fig. 1.


Cost-effectiveness of lifestyle modification in diabetic patients.

Jacobs-van der Bruggen MA, van Baal PH, Hoogenveen RT, Feenstra TL, Briggs AH, Lawson K, Feskens EJ, Baan CA - Diabetes Care (2009)

Cost-effectiveness acceptability curves for each intervention.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713648&req=5

Figure 1: Cost-effectiveness acceptability curves for each intervention.
Mentions: As expected, assuming 100% correlation between risk factor outcomes increased the variability of the simulated outcomes (supplementary Table A10, available in an online appendix). For example, for Look AHEAD, QALYs increased by 0.03–0.12 if outcomes were assumed to be independent and by 0.01–0.15 with 100% correlation. Similarly, the variability in simulated health care costs and CERs was higher if outcomes were assumed to be correlated (data not shown). The cost-effectiveness acceptability curves for the interventions, assuming correlated outcomes, are displayed in Fig. 1.

Bottom Line: A self-management education program (X-PERT) and physical activity counseling achieved the best results with > or =0.10 QALYs gained and > or =99% probability to be very cost-effective (< or =euro20,000/QALY).However, essential evidence for long-term maintenance of health benefits was limited.Future research should be focused on long-term effectiveness and multiple treatment strategies should be compared to determine incremental costs and benefits of one over the other.

View Article: PubMed Central - PubMed

Affiliation: Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. monique.jacobs@rivm.nl

ABSTRACT
OBJECTIVE To explore the potential long-term health and economic consequences of lifestyle interventions for diabetic patients. RESEARCH DESIGN AND METHODS A literature search was performed to identify interventions for diabetic patients in which lifestyle issues were addressed. We selected recent (2003-2008), randomized controlled trials with a minimum follow-up of 12 months. The long-term outcomes for these interventions, if implemented in the Dutch diabetic population, were simulated with a computer-based model. Costs and effects were discounted at, respectively, 4 and 1.5% annually. A lifelong time horizon was applied. Probabilistic sensitivity analyses were performed, taking account of variability in intervention costs and (long-term) treatment effects. RESULTS Seven trials with 147-5,145 participants met our predefined criteria. All interventions improved cardiovascular risk factors at > or =1 year follow-up and were projected to reduce cardiovascular morbidity over lifetime. The interventions resulted in an average gain of 0.01-0.14 quality-adjusted life-years (QALYs) per participant. Health benefits were generally achieved at reasonable costs (< or =euro50,000/QALY). A self-management education program (X-PERT) and physical activity counseling achieved the best results with > or =0.10 QALYs gained and > or =99% probability to be very cost-effective (< or =euro20,000/QALY). CONCLUSIONS Implementation of lifestyle interventions would probably yield important health benefits at reasonable costs. However, essential evidence for long-term maintenance of health benefits was limited. Future research should be focused on long-term effectiveness and multiple treatment strategies should be compared to determine incremental costs and benefits of one over the other.

Show MeSH
Related in: MedlinePlus