May 16, 2019BMC Health Services ResearchOpen Access

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

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Overweight or obesity with cardiovascular disease risk (n=194). Intervention: Strong Hearts, Healthy Communities (SHHC) program vs. Strong Hearts, Healthy Women (CON) education-only program. Primary outcome: Incremental cost-effectiveness ratio (ICER) per QALY gained (healthcare sector perspective) ($62,646 per QALY).

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Key result

The Strong Hearts, Healthy Communities intervention had an estimated incremental cost-effectiveness ratio of $62,646 per quality-adjusted life year gained from the healthcare sector perspective.

Why the study?

Rural women experience CVD risk disparities compared to urban women, creating a need for cost-effective CVD-prevention programs in this population.

Is the Strong Hearts, Healthy Communities (SHHC) lifestyle program cost-effective compared to an education-only control for reducing CVD risk factors in overweight and obese rural women?

Comparison

Strong Hearts, Healthy Communities (SHHC) lifestyle program vs monthly healthy lifestyle education control

Design

Cluster-randomized trial and cost-effectiveness analysis

Follow-up

Six-month intervention with 10-year time horizon modeling

Authors

HWHua WangTarim University DKDonald KenkelPepperdine University MGMeredith L. GrahamTexas A&M University System

Discussion

Member takes

Implication

Supports SHHC adoption for rural women from healthcare perspective; extends cost-effectiveness evidence for community-based CVD prevention programs.

Study Design

Type

RCT (n=194)

Randomization

Town level

Multicenter

Yes

Structured PICO

Is the Strong Hearts, Healthy Communities (SHHC) lifestyle program cost-effective compared to an education-only control for reducing CVD risk factors in overweight and obese rural women?

Population

194 sedentary, overweight or obese rural women aged 40 and older participated in a 6-month community-based cardiovascular disease prevention program.

Intervention

Strong Hearts, Healthy Communities (SHHC) program: a 6-month twice-weekly experiential learning lifestyle program focused on diet and physical activity (1 hour twice weekly for 24 weeks, 48 classes total).

Comparator

Strong Hearts, Healthy Women (CON) program: a reduced-dose, education-only, minimal intervention control program meeting for 1 hour once per month over 24 weeks (6 classes total).

Outcome

Incremental cost-effectiveness ratios (ICERs) in terms of cost per kg of weight loss, BMI reduction, CRP reduction, Simple 7 increase, and cost per quality-adjusted life year (QALY) saved over a 10-year time horizon.surrogate

Main Result

Effect estimate: $62,646 per QALY

A community-based intensive lifestyle intervention for rural women is likely cost-effective from a healthcare sector perspective, though societal costs per QALY are high due to participant time costs.

Limitations

Did not convert all intervention benefits (e.g., diabetes prevention from BMI reduction) into QALYs
Assumption that the intervention's benefit of ASCVD risk reduction would last for 10 years without additional costs may not be entirely reasonable
Using a prediction model for ASCVD risk score to estimate causal effects has limitations
Did not use a lifetime time horizon for the estimation of benefits and costs
Lacked cost information for ASCVD events specific to the study population
Program costs in rural areas may be higher than previously studied programs in more urban areas due to a lack of staff and physical activity resources
Relatively small sample size for estimating between-group change for ASCVD risk

Cite This Study

Wang et al. (2019) conducted an RCT in Overweight or obesity with cardiovascular disease risk (n=194). Strong Hearts, Healthy Communities (SHHC) program vs. Strong Hearts, Healthy Women (CON) education-only program was evaluated on Incremental cost-effectiveness ratio (ICER) per QALY gained (healthcare sector perspective) ($62,646 per QALY). The Strong Hearts, Healthy Communities intervention had an estimated incremental cost-effectiveness ratio of $62,646 per quality-adjusted life year gained from the healthcare sector perspective.

synapsesocial.com/papers/6a95d10eac8379d0a692c600 https://doi.org/10.1186/s12913-019-4117-y

Topics

Women and heart disease Cardiovascular prevention

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Implication

Supports SHHC adoption for rural women from healthcare perspective; extends cost-effectiveness evidence for community-based CVD prevention programs.

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider