Cost-Effectiveness and Impact of Lifestyle Intervention on Quality of Life

Compared with people who are physically active, people who lead sedentary lives are at a higher relative risk of mortality; unfit people have a higher risk than fit people. Lifestyle intervention programs aimed at increasing physical activity (PA) and changing dietary habits can delay the onset of diabetes mellitus (DM) and reduce cardiovascular risk. Studies on the long-term effects of lifestyle interventions on quality of life (QOL) and healthcare utilization are scarce. Researchers recently conducted a study to determine the impact of a primary healthcare-based lifestyle intervention program on QOL and cost-effectiveness over 3 years. They reported study results in Archives of Internal Medicine [2010;170(16):1470-1479]. The current study was a 3-year follow-up on a randomized controlled trial with lifestyle intervention in a primary care setting. The trial involved a population at moderate-to-high risk for cardiovascular disease; the intervention favorably reduced several risk factors. The follow-up analysis was based on the hypothesis that the program also improved QOL and was cost-effective. The study population included patients at a primary care center in northern Sweden who were 18 to 65 years of age who had hypertension, dyslipidemia, type 2 DM, obesity, or any combination of those conditions. Exclusion criteria included a diagnosis of coronary heart disease, stroke, severe hypertension, and severe psychiatric morbidity. After applying the exclusion criteria, there were 340 eligible patients; of those, 177 (52%) agreed to participate in the study. Prior to randomization, 18 withdrew and 8 met the exclusion criteria; the final study population of 151 patients was randomly assigned to the intervention group (n=75) or the control group (n=76). The intervention included supervised progressive exercise training 3 times per week and 5 sessions of dietary counseling during the initial 3 months, followed by group meetings. At the end of the initial 3 months, participants were invited to attend 6 group meetings during the next year, 4 meetings in the second year, and 2 meetings during the third year. Primary study outcome measures for the current analysis were change in QOL measured as the 5-dimensional EuroQol-5D (EQ-5D), the EuroQol visual analog scale (EQ-VAS), and the 6-dimensional Short-Form 6D (SF-6D). The health economic evaluation was done from a societal perspective and a treatment perspective. In a cost-utilization analysis, the costs, gained quality-adjusted life-years (QALYs), and savings in healthcare costs were considered. The net monetary benefit method was also used to describe the cost-effectiveness of the intervention. At the time of the 3-year follow-up analysis, 120 participants were included. The mean study population age was 54.4 years and 57% were female. The majority (86.8%) were overweight or obese and most had ≥1 additional risk factors; 54.5% were sedentary or minimally active, and 84.2% reported no exercise or <30 minutes of exercise per day. Smoking, DM, and treatment with lipid-lowering drugs were all more common in the intervention group; hypertension medication was more common in the control group. At baseline, participants in the intervention group reported less physical activity and had lower mean scores in all QOL questions. Over the 3-year follow-up period, scores on the EQ-5D did not change significantly. The EQ-VAS scores differed significantly between the 2 groups over the 3-year period (P=.002); there was greater improvement in the intervention group. Likewise, the improvement in the SF-6D mean score was greater in the intervention group compared with the control group (P=.01). There was improvement in the intervention group over the 3-year period in SF-6D dimensions in improved physical functioning (P=.02) and less bodily pain (P=.01), compared with the control group. There was greater improvement in the intervention group in the physical component summary compared with the control group (P=.04). There was no difference in the mental component summary. While the total costs for the intervention group were $337 higher than for the control group, when adjusted for QALYs and decreases in the number of visits to the family physician, the net savings for the intervention group was $47 per participant. In conclusion, the researchers summarized by saying “lifestyle intervention in primary care improves QOL and is highly cost-effective in relation to standard care.”