AN ECONOMIC-EVALUATION OF 4 WORK-SITE BASED CARDIOVASCULAR RISK FACTOR INTERVENTIONS

We used outcome data from a randomized work site intervention trial to examine the cost-effectiveness of Four cardiovascular disease (CVD) r isk reduction programs: health risk assessment (HRA), risk factor educ ation (RFE), behavioral counseling (BC), and behavioral counseling plu s incentives (BCI). Composite CVD risk scores were derived from measur es of serum total cholesterol; blood pressure, number of cigarettes sm oked, body mass index, and aerobic capacity. The economic evaluation o f the programs focused on the subset of costs most sensitive to the di fferences between the interventions, and a sensitivity analysis examin ed some of the relevant cost variations. At the 6-month follow-up (i.e ., the ''action'' or initiation stage of lifestyle change), the RFE, B C, and BCI interventions produced a significant reduction in cardiovas cular risk. Incremental analyses demonstrated RFE to be more cost-effe ctive, but not as clinically effective as BC; BC was more cost-effecti ve than RFE when assessment costs were included, and BCI was judged to be the least cost-effective. At the Ii-month follow-up (i.e., the ''m aintenance'' stage of lifestyle of change), BC was the only program fo und to produce a significant reduction in CVD risk. Individualized beh avioral counseling was found to be a cost-effective strategy for the i nitiation and maintenance of CVD risk factor reduction.