Lifestyle Intervention Improves Quality of Life and is Cost Effective

September 13, 2010 — An intervention delivered in a primary care setting aimed at getting patients at risk for heart disease to increase their physical activity and improve their diet improves quality of life and is highly cost-effective compared with standard care, according to a new study published in the September 13 issue of the Archives of Internal Medicine.

"Lifestyle interventions reduce cardiovascular risk and risk of diabetes mellitus, but reports on long-term effects on quality of life (QOL) and health care utilization are rare," write Margareta K. Eriksson, PhD, from Björknäs Health Care Center, Boden, and Umeå University, Umeå, Sweden, and colleagues.

The authors add: "For a comprehensive assessment of an intervention program it is essential to incorporate the individual's broader perspective of well-being, not only the conventional medical outcomes."

The aim of this study was to investigate the effect of a primary healthcare-based lifestyle intervention program on QOL and cost-effectiveness over 3 years.

The study included 151 men and women, aged 18 to 65 years (mean age, 54.4 years), who were at moderate to high risk for cardiovascular disease and who were recruited from a primary care center in northern Sweden. The patients were randomly assigned to receive either lifestyle intervention or standard care alone.

Intervention consisted of supervised progressive exercise training 3 times a week and 5 diet counseling sessions during the first 3 months, followed by regular group meetings, held 6 times in the first year, 4 times in the second year, and 2 times in the third year.

The group meetings were small, consisting of 10 to 13 participants, and focused on goal-setting, action planning, and avoiding relapse. Patients were also asked to think about benefits, barriers, and costs of adhering to a healthier lifestyle.

The exercise sessions were led by physiotherapists and consisted of Nordic walking, aqua-aerobics, and interval training on a bicycle ergometer combined with circuit-type resistance training.

The control group received verbal and written information about diet and exercise at a single group meeting.

Both groups were asked to complete activity diaries.

Primary outcomes were change in QOL as measured by the EuroQol 5D (EQ-5D), which measured mobility, self-care, usual activities, pain/discomfort, and anxiety/depression; the EuroQol visual analog scale (EQ-VAS), which recorded perception of overall health status on a modified gradient from 0, meaning the worst imaginable health, to 1, meaning the best imaginable health; the 36-item Short-Form-Health Survey (SF-36), which measures physical functioning, limitations in physical role functioning, body pain, general health, vitality, social functioning, limitations in emotional role functioning, and mental health; and the 6-dimensional Short-Form 6D (SF-6D).

The study found differences between the 2 groups during the 3-year study period for most of the QOL measures. Significant differences between the groups were shown in the EQ-VAS (P = .002), SF-6D (P = .01), and SF-36 physical component (P = .04) scores. However, there was no difference in the EQ-5D (P = .24) or SF-36 mental component (P = .37) scores.

Costs were $337 higher for the intervention group than for the control group. This included $140 that participants paid for their increased physical activity and $197 financed by the healthcare system. However, the mean number of visits to the family physician decreased in the intervention group by 0.28 per half-year compared with baseline and increased by 0.10 in the control group (P = .04), the authors report. This translated to a net savings of $47 per participant in the intervention group compared with the control group.

Gross costs per quality adjusted life-year (QALY) gained were from $1668 to $4813, and this did not include the savings, the authors report. Probabilities of cost-effectiveness were from 89% to 100% when the amount of $50,000 was used as stakeholder's threshold of willingness to pay for a gained QALY.

The main reason for cost-effectiveness was the increase in exercise level that was sustained throughout the 3 years of the study.

"The study was initially powered for anthropometric measurements, not for QOL, and may thus be too small to detect significant improvements in less responsive scales," the authors write, noting a limitation.

" High-intensity and long-lasting interventions can produce sustainable improvements in QOL and can obviously be cost-effective," Dr. Eriksson and colleagues conclude. "Such programs may be a wise use of resources in primary health care for patients with diseases to which inactivity strongly contributes."