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Kolovos S, Finch AP, van der Ploeg HP, van Nassau F, Broulikova HM, Baka A, Treweek S, Gray CM, Jelsma JGM, Bunn C, Roberts GC, Silva MN, Gill JMR, Røynesdal Ø, van Mechelen W, Andersen E, Hunt K, Wyke S, Bosmans JE. Five-year cost-effectiveness analysis of the European Fans in Training (EuroFIT) physical activity intervention for men versus no intervention. Int J Behav Nutr Phys Act 2020; 17:30. [PMID: 32131849 PMCID: PMC7055048 DOI: 10.1186/s12966-020-00934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/17/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Increasing physical activity reduces the risk of chronic illness including Type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle interventions can increase physical activity but few successfully engage men. This study aims to investigate the 5 year cost-effectiveness of EuroFIT, a program to improve physical activity tailored specifically for male football (soccer) fans compared to a no intervention comparison group. Methods We developed a Markov cohort model in which the impact of improving physical activity on five chronic health conditions (colorectal cancer, Type 2 diabetes, coronary heart disease, stroke and depression) and mortality was modelled. We estimated costs from a societal perspective and expressed benefits as quality adjusted life years (QALYs). We obtained data from a 4-country (England, Netherlands, Portugal and Norway) pragmatic randomised controlled trial evaluating EuroFIT, epidemiological and cohort studies, and meta-analyses. We performed deterministic and probabilistic sensitivity analyses to assess the impact of uncertainty in the model’s parameter values on the cost-effectiveness results. We used Monte Carlo simulations to estimate uncertainty and presented this using cost-effectiveness acceptability curves (CEACs). We tested the robustness of the base case analysis using five scenario analyses. Results Average costs over 5 years per person receiving EuroFIT were €14,663 and per person receiving no intervention €14,598. Mean QALYs over 5 years were 4.05 per person for EuroFIT and 4.04 for no intervention. Thus, the average incremental cost per person receiving EuroFIT was €65 compared to no intervention, while the average QALY gain was 0.01. This resulted in an ICER of €5206 per QALY gained. CEACs show that the probability of EuroFIT being cost-effective compared to no intervention is 0.53, 0.56 and 0.58 at thresholds of €10,000, €22,000 and €34,000 per QALY gained, respectively. When using a time horizon of 10 years, the results suggest that EuroFIT is more effective and less expensive compared to (i.e. dominant over) no intervention with a probability of cost-effectiveness of 0.63 at a threshold of €22,000 per QALY gained. Conclusions We conclude the EuroFIT intervention is not cost-effective compared to no intervention over a period of 5 years from a societal perspective, but is more effective and less expensive (i.e. dominant) after 10 years. We thus suggest that EuroFIT can potentially improve public health in a cost-effective manner in the long term.
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Affiliation(s)
- Spyros Kolovos
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Aureliano P Finch
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Hidde P van der Ploeg
- Amsterdam UMC, VU medical center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
| | - Femke van Nassau
- Amsterdam UMC, VU medical center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
| | - Hana M Broulikova
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Agni Baka
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cindy M Gray
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Judith G M Jelsma
- Amsterdam UMC, VU medical center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
| | - Christopher Bunn
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Glyn C Roberts
- Department of coaching and psychology, Norwegian School of Sport Science, Oslo, Norway
| | - Marlene N Silva
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Educação Física e Desporto, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Øystein Røynesdal
- Department of coaching and psychology, Norwegian School of Sport Science, Oslo, Norway.,Department of Teacher Education, NLA University College, Bergen, Norway
| | - Willem van Mechelen
- Amsterdam UMC, VU medical center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
| | - Eivind Andersen
- Department of coaching and psychology, Norwegian School of Sport Science, Oslo, Norway
| | - Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
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Wubishet BL, Harris ML, Forder PM, Acharya SH, Byles JE. Predictors of 15-year survival among Australian women with diabetes from age 76-81. Diabetes Res Clin Pract 2019; 150:48-56. [PMID: 30807777 DOI: 10.1016/j.diabres.2019.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
AIMS To assess the impact of diabetes on the survival of older women, adjusted for other all-cause mortality predictors. METHODS Data were used from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health, when the women were aged 76-81 years at baseline, with linkage to the National Death Index. Survival curves were plotted to compare the survival of women with no diabetes, incident diabetes and prevalent diabetes over 15 years. Cox proportional hazards models were used to examine the association between diabetes and all-cause mortality risks. RESULTS A total of 972 (11.7%) of 8296 eligible women reported either incident, 522 (6.3%) or prevalent, 450 (5.4%) diabetes. The median survival times were 10.1, 11.4 and 12.7 years among women with prevalent, incident and no diabetes, respectively. The risks of death were 30% [HR: 1.30 (95% CI: 1.16-1.45)] and 73% [HR: 1.73 (CI: 1.57-1.92)] higher for women with incident and prevalent diabetes compared to women without diabetes. These associations were sustained after controlling for demographics, body mass index, smoking status, comorbidities and health care use. CONCLUSIONS This study revealed that diabetes is associated with reduced survival probabilities for older women with minimal moderation after adjustment for other predictors. Our findings suggest that diabetes management guidelines for older women need to integrate factors such as comorbidities, smoking and being underweight to reduce the risk of mortality.
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Affiliation(s)
- Befikadu L Wubishet
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia; Department of Pharmacy, Mekelle University, Mekelle, Tigray, Ethiopia.
| | - Melissa L Harris
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | - Peta M Forder
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | | | - Julie E Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
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Mewes JC, Ahmed SA, Vrijhoef HJM. How do integrated care programmes work for patients with cardiovascular disease, chronic obstructive pulmonary disease, depression, diabetes and multi-morbidity? A rapid realist review. INTERNATIONAL JOURNAL OF CARE COORDINATION 2018. [DOI: 10.1177/2053434518788593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In previous years, many multi-faceted initiatives have been set up to improve outcomes for people with chronic diseases. Evaluation studies about the (cost-)effectiveness of these integrated care programs showed heterogeneity in outcomes. Hence, it has been suggested to use realist evaluation for the evaluation of integrated care programmes. Thus, our aim was to gain insight into whether and how existing integrated care programmes work for people with cardiovascular disease, chronic obstructive pulmonary disease, depression, diabetes and multi-morbidity, and under what conditions within the Dutch healthcare setting. Methods A rapid realist review was conducted to identify the context and mechanisms that are associated with the outcomes of integrated care programmes. From a selection of systematic reviews and meta-analyses and Dutch literature, data on the context, mechanisms and outcomes of integrated care programmes were extracted. The data were analysed by placing the extracted variables in context-mechanism-outcome configurations which showed their interrelatedness. A panel of executives from Dutch care groups assessed the face validity of the context-mechanism-outcome configurations. Results Based on the existing literature, context-mechanism-outcome configurations were compiled for all five diseases. Some configurations could be filled with more detail than others, with the configuration of integrated care for people with diabetes being the most complete. Context-mechanism-outcome configurations were completed and confirmed by executives from Dutch care groups. Conclusion The configurations together with the identified factors in them reveal the underlying preliminary program theories of integrated care programmes. These theories need to be tested in further research.
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Affiliation(s)
| | | | - HJM Vrijhoef
- Panaxea b.v., The Netherlands
- Maastricht University Medical Center, The Netherlands
- Vrije Universiteit Brussel, Belgium
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