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)
Abstract Background Multiple 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...
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | International Journal of Behavioral Nutrition and Physical Activity |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12966-021-01144-5 |
| _version_ | 1826932639792103424 |
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| author | Ignacio Aznar-Lou Edurne Zabaleta-Del-Olmo Marc Casajuana-Closas Alba Sánchez-Viñas Elizabeth Parody-Rúa Bonaventura Bolíbar Montserrat Iracheta-Todó Oana Bulilete Tomàs López-Jiménez Haizea Pombo-Ramos María Victoria Martín Miguel Rosa Magallón-Botaya Jose Ángel Maderuelo-Fernández Emma Motrico Juan Bellón Ruth Martí-Lluch Maria Rubio-Valera Antoni Serrano-Blanco |
| author_facet | Ignacio Aznar-Lou Edurne Zabaleta-Del-Olmo Marc Casajuana-Closas Alba Sánchez-Viñas Elizabeth Parody-Rúa Bonaventura Bolíbar Montserrat Iracheta-Todó Oana Bulilete Tomàs López-Jiménez Haizea Pombo-Ramos María Victoria Martín Miguel Rosa Magallón-Botaya Jose Ángel Maderuelo-Fernández Emma Motrico Juan Bellón Ruth Martí-Lluch Maria Rubio-Valera Antoni Serrano-Blanco |
| author_sort | Ignacio Aznar-Lou |
| collection | DOAJ |
| description | Abstract Background Multiple 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. Methods An 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. Results The 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 0.17 respectively). The ICER was €5,598 per extra health behaviour change in one patient and €1,727 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. Conclusion The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. Trial registration Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 – Retrospectively registered |
| first_indexed | 2024-12-20T10:59:51Z |
| format | Article |
| id | doaj.art-e44328a0c6cb4abe8a9d7ecd35ff8a62 |
| institution | Directory Open Access Journal |
| issn | 1479-5868 |
| language | English |
| last_indexed | 2025-02-17T17:18:41Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Behavioral Nutrition and Physical Activity |
| spelling | doaj.art-e44328a0c6cb4abe8a9d7ecd35ff8a622024-12-15T12:12:47ZengBMCInternational Journal of Behavioral Nutrition and Physical Activity1479-58682021-07-0118111510.1186/s12966-021-01144-5Cost-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)Ignacio Aznar-Lou0Edurne Zabaleta-Del-Olmo1Marc Casajuana-Closas2Alba Sánchez-Viñas3Elizabeth Parody-Rúa4Bonaventura Bolíbar5Montserrat Iracheta-Todó6Oana Bulilete7Tomàs López-Jiménez8Haizea Pombo-Ramos9María Victoria Martín Miguel10Rosa Magallón-Botaya11Jose Ángel Maderuelo-Fernández12Emma Motrico13Juan Bellón14Ruth Martí-Lluch15Maria Rubio-Valera16Antoni Serrano-Blanco17Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de DéuFundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de DéuResearch and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de DéuFundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de DéuPrimary Care Research Unit, Mallorca, Balearic Public Health ServiceFundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)Primary Care Research Unit of Bizkaia, Basque Health Service-OsakidetzaVigo Primary Health CareIIS-Aragón Grupo b21-17R, Universidad de ZaragozaPrimary Health Care Research Unit of Salamanca (APISAL), Health Service of Castilla y León (SACyL), Institute of Biomedical Research of Salamanca (IBSAL)Primary Care Prevention and Health Promotion Network (redIAPP)Primary Care Prevention and Health Promotion Network (redIAPP)Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de DéuResearch and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de DéuAbstract Background Multiple 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. Methods An 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. Results The 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 0.17 respectively). The ICER was €5,598 per extra health behaviour change in one patient and €1,727 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. Conclusion The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. Trial registration Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 – Retrospectively registeredhttps://doi.org/10.1186/s12966-021-01144-5Economic evaluationHealth promotionPrimary careHybrid trial |
| spellingShingle | Ignacio Aznar-Lou Edurne Zabaleta-Del-Olmo Marc Casajuana-Closas Alba Sánchez-Viñas Elizabeth Parody-Rúa Bonaventura Bolíbar Montserrat Iracheta-Todó Oana Bulilete Tomàs López-Jiménez Haizea Pombo-Ramos María Victoria Martín Miguel Rosa Magallón-Botaya Jose Ángel Maderuelo-Fernández Emma Motrico Juan Bellón Ruth Martí-Lluch Maria Rubio-Valera Antoni Serrano-Blanco 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 Economic evaluation Health promotion Primary care Hybrid trial |
| title | 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) |
| title_full | 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) |
| title_fullStr | 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) |
| title_full_unstemmed | 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) |
| title_short | 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) |
| title_sort | 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 |
| topic | Economic evaluation Health promotion Primary care Hybrid trial |
| url | https://doi.org/10.1186/s12966-021-01144-5 |
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