Cost-effectiveness of a community-based cardiovascular disease prevention intervention in medically underserved rural areas

Hua Wang,Sara C Folta,Miriam E Nelson,Lynn C Paul,David Strogatz,Rebecca A Seguin,Donald Kenkel,Meredith L Graham

doi:10.1186/s12913-019-4117-y

Abstract

BackgroundRural 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).MethodsSixteen 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.ResultsThe 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.ConclusionsA 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 registrationClinicalTrials.gov identifier NCT02499731, registered on July 16, 2015.

Highlights

Rural women experience health disparities in terms of cardiovascular disease (CVD) risk compared to urban women
We report the results of economic evaluations of a rural community-based CVD prevention program targeted at overweight and obese rural women aged 40 and older
Health outcomes In one set of Costeffectiveness analysis (CEA), we used the health outcomes measured in the efficacy trial. In these CEAs we examined the cost per kg of body weight reduction; the cost per point of BMI reduction; the cost per mg/L of C-reactive protein (CRP) reduction; and the cost per point of Simple 7 increase

Summary

Introduction

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. Rural populations face CVD-related health disparities compared to their urban counterparts; they are less likely to meet physical activity recommendations and more likely to smoke, be overweight, and have type 2 diabetes [2, 3]. Environmental aspects of rural areas, including limited access to physical activity opportunities, healthy foods, and healthcare resources, contribute to development of these risk factors [4,5,6]. Prevention adds to healthcare costs, but can still provide an attractive return on investment compared to other options to improve health [10]

Objectives

Methods

Results

Discussion

Conclusion