Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Cost Eff Resour Alloc. 2013 Aug 28;11(1):19. doi: 10.1186/1478-7547-11-19.
Clinical trials have indicated that lifestyle interventions for patients with lifestyle-related cardiovascular and diabetes risk factors (the metabolic syndrome) are cost-effective. However, patient characteristics in primary care practice vary considerably, i.e. they exhibit heterogeneity in risk factors. The cost-effectiveness of lifestyle interventions is likely to differ over heterogeneous patient groups.
Patients (62 men, 80 women) in the Kalmar Metabolic Syndrome Program (KMSP) in primary care (Kalmar regional healthcare area, Sweden) were divided into three groups reflecting different profiles of metabolic risk factors (low, middle and high risk) and gender. A Markov model was used to predict future cardiovascular disease and diabetes, including complications (until age 85 years or death), with health effects measured as QALYs and costs from a societal perspective in Euro (EUR) 2012, discounted 3%. Simulations with risk factor levels at start and at 12 months follow-up were performed for each group, with an assumed 4-year sustainability of intervention effects.
The program was estimated cost-saving for middle and high risk men, while the incremental cost vs. do-nothing varied between EUR 3,500 - 18,000 per QALY for other groups. There is heterogeneity in the cost-effectiveness over the risk groups but this does not affect the overall conclusion on the cost-effectiveness of the KMSP. Even the highest ICER (for high risk women) is considered moderately cost-effective in Sweden. The base case result was not sensitive to alternative data and methodology but considerably affected by sustainability assumptions. Alternative risk stratifications did not change the overall conclusion that KMSP is cost-effective. However, simple grouping with average risk factor levels over gender groups overestimate the cost-effectiveness.
Lifestyle counseling to prevent metabolic diseases is cost-effective in Swedish standard primary care settings. The use of risk stratification in the cost-effectiveness analysis established that the program was cost-effective for all patient groups, even for those with very high levels of lifestyle-related risk factors for the metabolic syndrome diseases. Heterogeneity in the cost-effectiveness of lifestyle interventions in primary care patients is expected, and should be considered in health policy decisions.
临床试验表明，针对与生活方式相关的心血管和糖尿病风险因素（代谢综合征）的生活方式干预措施对患者而言具有成本效益。然而，初级保健实践中的患者特征差异很大，即他们的风险因素存在异质性。生活方式干预措施的成本效益可能因不同的患者群体而异。
在初级保健中的卡尔马代谢综合征计划（KMSP）中，将患者（62 名男性，80 名女性）分为三组，反映了不同代谢风险因素（低、中、高风险）和性别特征的不同模式。使用马尔可夫模型预测未来的心血管疾病和糖尿病，包括并发症（直至 85 岁或死亡），并从社会角度以欧元（EUR）2012 年为单位衡量健康效果（贴现率为 3%）。对每组进行了起始和 12 个月随访时的风险因素水平模拟，假设干预效果可持续 4 年。
该计划被估计对中高风险男性具有成本效益，而对于其他群体，与不采取任何措施相比，增量成本-效益比在每 QALY 3500-18000 欧元之间变化。风险组之间的成本效益存在异质性，但这并不影响对 KMSP 成本效益的总体结论。即使是最高的增量成本效益比（高风险女性）在瑞典也被认为是具有中度成本效益的。基本案例结果对替代数据和方法不敏感，但对可持续性假设的影响较大。替代风险分层并没有改变 KMSP 具有成本效益的总体结论。然而，基于性别组平均风险因素水平的简单分组会高估成本效益。
在瑞典标准的初级保健环境中，生活方式咨询预防代谢性疾病具有成本效益。在成本效益分析中使用风险分层，确定该计划对所有患者群体都具有成本效益，即使是那些代谢综合征疾病与生活方式相关风险因素水平非常高的患者。预计初级保健患者的生活方式干预措施的成本效益存在异质性，应在卫生政策决策中予以考虑。
