Cost-effectiveness of a community-based cardiovascular disease prevention intervention in medically underserved rural areas
| العنوان: | Cost-effectiveness of a community-based cardiovascular disease prevention intervention in medically underserved rural areas |
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| المؤلفون: | David Strogatz, Rebecca A. Seguin, Sara C. Folta, Hua Wang, Miriam E. Nelson, Donald Kenkel, Lynn Paul, Meredith L. Graham |
| المصدر: | BMC Health Services Research BMC Health Services Research, Vol 19, Iss 1, Pp 1-13 (2019) |
| بيانات النشر: | Springer Science and Business Media LLC, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Cost effectiveness, Cost-Benefit Analysis, Health Behavior, Medically Underserved Area, Cardiovascular disease prevention, Overweight, 0302 clinical medicine, Risk Factors, Preventive Health Services, Medicine, Rural, 030212 general & internal medicine, health care economics and organizations, education.field_of_study, Montana, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, 1. No poverty, Cost-effectiveness analysis, Middle Aged, Health equity, 3. Good health, Cardiovascular Diseases, Female, Quality-Adjusted Life Years, medicine.symptom, 0305 other medical science, Research Article, Adult, Population, New York, 03 medical and health sciences, Environmental health, Weight Loss, Humans, Women, education, Aged, business.industry, Quality adjusted life years, lcsh:RA1-1270, Economic evaluation, Quality-adjusted life year, Rural Health Services, Rural area, business |
| الوصف: | Background Rural women experience health disparities in terms of cardiovascular disease (CVD) risk compared to urban women. Cost-effective CVD-prevention programs are needed for this population. The objective of this study was to conduct cost analysis and cost-effectiveness analyses (CEAs) of the Strong Hearts, Healthy Communities (SHHC) program compared to a control program in terms of change in CVD risk factors, including body weight and quality-adjusted life years (QALYs). Methods Sixteen medically underserved rural towns in Montana and New York were randomly assigned to SHHC, a six-month twice-weekly experiential learning lifestyle program focused predominantly on diet and physical activity behaviors (n = 101), or a monthly healthy lifestyle education-only control program (n = 93). Females who were sedentary, overweight or obese, and aged 40 years or older were enrolled. The cost analysis calculated the total and per participant resource costs as well as participants’ costs for the SHHC and control programs. In the intermediate health outcomes CEAs, the incremental costs were compared to the incremental changes in the outcomes. The QALY CEA compares the incremental costs and effectiveness of a national SHHC intervention for a hypothetical cohort of 2.2 million women compared to the status quo alternative. Results The resource cost of SHHC was $775 per participant. The incremental cost-effectiveness ratios from the payer’s perspective was $360 per kg of weight loss. Over a 10-year time horizon, to avert per QALY lost SHHC is estimated to cost $238,271 from the societal perspective, but only $62,646 from the healthcare sector perspective. Probabilistic sensitivity analyses show considerable uncertainty in the estimated incremental cost-effectiveness ratios. Conclusions A national SHHC intervention is likely to be cost-effective at willingness-to-pay thresholds based on guidelines for federal regulatory impact analysis, but may not be at commonly used lower threshold values. However, it is possible that program costs in rural areas are higher than previously studied programs in more urban areas, due to a lack of staff and physical activity resources as well as availability for partnerships with existing organizations. Trial registration ClinicalTrials.gov identifier NCT02499731, registered on July 16, 2015. |
| تدمد: | 1472-6963 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::aae048f7144aa90ced90e7a97ac545c4Test https://doi.org/10.1186/s12913-019-4117-yTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....aae048f7144aa90ced90e7a97ac545c4 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14726963 |
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