El Alili Mohamed, van Meijel Berno, van Tulder Maurits W, Adriaanse Marcel
Department of Health Sciences, Vrije Universiteit Amsterdam, Faculty of Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Zorginstituut Nederland, Diemen, The Netherlands.
PLoS One. 2025 Jan 6;20(1):e0313100. doi: 10.1371/journal.pone.0313100. eCollection 2025.
Only studying effectiveness of lifestyle interventions for people with severe mental illness (SMI) is insufficient for policy making. As budgets for healthcare are limited, policy makers face the problem of allocating scarce healthcare resources. Cost-effectiveness studies are needed, but currently cost-effectiveness studies of lifestyle interventions for people with SMI delivered in ambulatory care are limited. The aim of this current study was to evaluate the cost-effectiveness of a lifestyle intervention for people with SMI living in the Dutch community in comparison with usual care.
An economic evaluation was performed using a societal perspective alongside the Severe Mental Illness Lifestyle Evaluation (SMILE) pragmatic cluster randomized controlled trial. The SMILE lifestyle intervention is a one-year, group-based intervention delivered by trained mental healthcare workers. Costs, body weight change and quality of life were assessed at baseline, 6 and 12 months. Mixed models were used to estimate incremental costs and effects between the treatment group and the usual care group. Overall, the SMILE intervention resulted in lower total costs compared to the usual care group (-€719, 95% CI -7133; 3897). The effect difference between the intervention and usual care groups was -3.76 (95% CI -6.30; -1.23) kilograms for body weight and -0.037 (95% CI -0.083; 0.010) for QALYs.
Overall, the SMILE intervention resulted in lower total costs compared to the usual care group and was cost-effective for body weight change. However, the SMILE intervention does not seem cost-effective with regards to QALYs. More cost-effectiveness studies in other countries and other settings are needed to gain further insight into the cost-effectiveness of lifestyle interventions for people with SMI.
仅研究生活方式干预对重症精神疾病（SMI）患者的有效性对于政策制定而言是不够的。由于医疗保健预算有限，政策制定者面临着分配稀缺医疗资源的问题。需要进行成本效益研究，但目前在门诊护理中为SMI患者提供生活方式干预的成本效益研究有限。本研究的目的是评估与常规护理相比，针对生活在荷兰社区的SMI患者进行生活方式干预的成本效益。
在重症精神疾病生活方式评估（SMILE）实用整群随机对照试验的同时，从社会角度进行了经济评估。SMILE生活方式干预是一项为期一年、由经过培训的精神卫生保健工作者提供的基于小组的干预。在基线、6个月和12个月时评估成本、体重变化和生活质量。使用混合模型估计治疗组和常规护理组之间的增量成本和效果。总体而言，与常规护理组相比，SMILE干预导致总成本更低（-719欧元，95%可信区间-7133；3897）。干预组和常规护理组之间的效果差异为体重-3.76（95%可信区间-6.30；-1.23）千克，质量调整生命年（QALYs）为-0.037（95%可信区间-0.083；0.010）。
总体而言，与常规护理组相比，SMILE干预导致总成本更低，且在体重变化方面具有成本效益。然而，就QALYs而言，SMILE干预似乎不具有成本效益。需要在其他国家和其他环境中进行更多成本效益研究，以进一步了解针对SMI患者的生活方式干预的成本效益。
