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)
Aznar-Lou, Ignacio (Institut de Recerca Sant Joan de Déu)
Zabaleta del Olmo, Edurne (Universitat Autònoma de Barcelona)
Casajuana Closas, Marc (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Sánchez-Viñas, Alba (Institut de Recerca Sant Joan de Déu)
Parody-Rúa, Elizabeth (Institut de Recerca Sant Joan de Déu)
Bolíbar, Bonaventura (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Iracheta-Todó, Montserrat (Institut de Recerca Sant Joan de Déu)
Bulilete, Oana (Institut d'Investigació Sanitària Illes Balears)
López-Jiménez, Tomàs (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Pombo Ramos, Haizea (Instituto de Investigación Sanitaria Biocruces Bizkaia)
Martín Miguel, María Victoria (Vigo Primary Health Care)
Magallón-Botaya, Rosa (Servicio Aragonés de Salud)
Maderuelo-Fernandez, Jose-Angel (Instituto de Investigación Biomédica de Salamanca)
Motrico, Emma (Universidad Loyola)
Bellón Saameño, Juan Ángel (Instituto de Investigación Biomédica de Málaga)
Martí-Lluch, Ruth (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Rubio-Valera, Maria (Institut de Recerca Sant Joan de Déu)
Serrano-Blanco, Antoni (Institut de Recerca Sant Joan de Déu)

Date:	2021
Abstract:	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. 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. 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. 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. The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. Clinicaltrials. gov . Registered 02 May 2017 - Retrospectively registered The online version contains supplementary material available at 10. 1186/s12966-021-01144-5.
Grants:	Instituto de Salud Carlos III FIS PI15-00114 Instituto de Salud Carlos III FIS PI15-00519 Instituto de Salud Carlos III CB16/02/00322 Instituto de Salud Carlos III RD12/0005/0006 Instituto de Salud Carlos III RD12/0005/0008
Note:	Altres ajuts: This study was supported by a grant from the Department of Health of the government of Catalonia, Spain (SLT002/16/00112); and a grant awarded by the "Pla Estratègic de Recerca i Innovació en Salut" (PERIS) (Strategic Plan for Health Research and Innovation) at the Ministry of Health (Government of Catalonia) (SLT002/16/00190). We thank the European Union ERDF funds for support in the development of this study. MRV has a "Miguel Servet" research contract from the Instituto de Salud Carlos III (ISCIII) at the Ministry of Economy and Competitiveness (Spain) (CP19/00029). ASB has a personal grant funded by the PERIS programme (SLT006/17/68), Generalitat de Catalunya (Spain), to partially dedicate his time to research during the time the study was conducted
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Estudi clínic ; recerca ; Versió publicada
Subject:	Economic evaluation ; Health promotion ; Primary care ; Hybrid trial
Published in:	The international journal of behavioral nutrition and physical activity, Vol. 18 (july 2021) , ISSN 1479-5868

DOI: 10.1186/s12966-021-01144-5
PMID: 34215275

15 p, 1.0 MB

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