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Lifestyle Intervention from a Health Economics Perspective

Saha, Sanjib LU (2015) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2015:25.
Abstract
Abstract

The aim of this thesis was to perform health economic analyses of lifestyle intervention for people at a high risk of cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2DM). The results can help decision-makers to make informed decisions over implementing lifestyle intervention, taking several dilemmas into consideration.

Paper I provides evidence on the cost-effectiveness of lifestyle intervention for the prevention of CVDs and T2DM. We found that 10 research groups in 9 countries demonstrated that 10 of 11 analyses of lifestyle intervention were cost-effective. Adherence to the lifestyle changes is one important predictor for the cost-effectiveness of an intervention.

In Paper II, we... (More)
Abstract

The aim of this thesis was to perform health economic analyses of lifestyle intervention for people at a high risk of cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2DM). The results can help decision-makers to make informed decisions over implementing lifestyle intervention, taking several dilemmas into consideration.

Paper I provides evidence on the cost-effectiveness of lifestyle intervention for the prevention of CVDs and T2DM. We found that 10 research groups in 9 countries demonstrated that 10 of 11 analyses of lifestyle intervention were cost-effective. Adherence to the lifestyle changes is one important predictor for the cost-effectiveness of an intervention.

In Paper II, we performed a long-term cost-effectiveness analysis of a randomized controlled trial of lifestyle intervention (the Swedish Björknäs study) with a decision-analytic Markov model (DAM). A differences-in-differences approach was used to control for baseline differences between the two groups, and three-year follow-up data were extrapolated over a lifetime. The DAM predicted that the lifestyle intervention was cost-saving from a societal perspective (US$-7500; +0.46 QALY), but would no longer be cost-saving if the effectiveness lasted only for the intervention period.

In Paper III, we revisited the cost-effectiveness of the Björknäs study with seven-year follow-up data, and compared a real-world control group to the within-trial control group to capture the “do nothing” scenario. An observational cohort, the Swedish MONICA study was used to identify a real-world general population, and matched with the Björknäs study participants by propensity score matching. The results showed the intervention to still be cost-saving with seven-year follow-up data (US$-6100; +0.45 QALY), and the benefit to be even higher when comparing a real-world general population (US$-16600; +0.35 QALY).

In Paper IV, we used register data on the real-life healthcare resource utilization of the Björknäs participants over a 10-year period to estimate the long-term benefit with real-life data instead of DAM-based predictions. We used a generalized estimating equation and controlled for baseline characteristics including healthcare expenditures. The results showed that the intervention group had a downward trend of outpatient and total expenditures in the long term, while the control group had an upward trend. The real-life findings from registers confirmed and complemented the DAM-based findings.

Lifestyle intervention has long-term benefits, and decision-makers need to implement lifestyle intervention in primary care for people at high risk of CVDs and T2DM; this will save valuable societal resources. (Less)
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author
supervisor
opponent
  • Asplund, Kjell, Department of Public Health and Clinical Medicine, Umeå University, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
lifestyle intervention, decision-analytic model, differences-in-differences approach, real-world
categories
Higher Education
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2015:25
pages
73 pages
publisher
Department of Clinical Sciences, Lund University
defense location
School of Economics and Management, EC3:210
defense date
2015-03-18 10:00
ISSN
1652-8220
ISBN
978-91-7619-104-0
language
English
LU publication?
yes
id
b87a95cc-7bfc-4d26-ac31-c338a7ccde5b (old id 5204853)
date added to LUP
2015-03-25 10:38:14
date last changed
2016-09-19 08:44:46
@phdthesis{b87a95cc-7bfc-4d26-ac31-c338a7ccde5b,
  abstract     = {Abstract<br/><br>
The aim of this thesis was to perform health economic analyses of lifestyle intervention for people at a high risk of cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2DM). The results can help decision-makers to make informed decisions over implementing lifestyle intervention, taking several dilemmas into consideration.<br/><br>
Paper I provides evidence on the cost-effectiveness of lifestyle intervention for the prevention of CVDs and T2DM. We found that 10 research groups in 9 countries demonstrated that 10 of 11 analyses of lifestyle intervention were cost-effective. Adherence to the lifestyle changes is one important predictor for the cost-effectiveness of an intervention.<br/><br>
In Paper II, we performed a long-term cost-effectiveness analysis of a randomized controlled trial of lifestyle intervention (the Swedish Björknäs study) with a decision-analytic Markov model (DAM). A differences-in-differences approach was used to control for baseline differences between the two groups, and three-year follow-up data were extrapolated over a lifetime. The DAM predicted that the lifestyle intervention was cost-saving from a societal perspective (US$-7500; +0.46 QALY), but would no longer be cost-saving if the effectiveness lasted only for the intervention period.<br/><br>
In Paper III, we revisited the cost-effectiveness of the Björknäs study with seven-year follow-up data, and compared a real-world control group to the within-trial control group to capture the “do nothing” scenario. An observational cohort, the Swedish MONICA study was used to identify a real-world general population, and matched with the Björknäs study participants by propensity score matching. The results showed the intervention to still be cost-saving with seven-year follow-up data (US$-6100; +0.45 QALY), and the benefit to be even higher when comparing a real-world general population (US$-16600; +0.35 QALY).<br/><br>
In Paper IV, we used register data on the real-life healthcare resource utilization of the Björknäs participants over a 10-year period to estimate the long-term benefit with real-life data instead of DAM-based predictions. We used a generalized estimating equation and controlled for baseline characteristics including healthcare expenditures. The results showed that the intervention group had a downward trend of outpatient and total expenditures in the long term, while the control group had an upward trend. The real-life findings from registers confirmed and complemented the DAM-based findings.<br/><br>
Lifestyle intervention has long-term benefits, and decision-makers need to implement lifestyle intervention in primary care for people at high risk of CVDs and T2DM; this will save valuable societal resources.},
  author       = {Saha, Sanjib},
  isbn         = {978-91-7619-104-0},
  issn         = {1652-8220},
  keyword      = {lifestyle intervention,decision-analytic model,differences-in-differences approach,real-world},
  language     = {eng},
  pages        = {73},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Lifestyle Intervention from a Health Economics Perspective},
  volume       = {2015:25},
  year         = {2015},
}