THE COST-EFFECTIVENESS OF A CARDIOVASCULAR RISK REDUCTION PROGRAM IN GENERAL-PRACTICE

An economic evaluation was conducted alongside a randomised controlled trial of two lifestyle interventions and a routine care (control) gro up to assess the cost-effectiveness of a general practice-based lifest yle change program for patients with risk factors for cardiovascular d isease. Routine care was the base case comparator because it represent s 'current therapy' for cardiovascular disease (CVD). A 'no care' cont rol group was not considered a clinically acceptable alternative to li festyle interventions. The interventions consisted of an education gui de and video for GPs to assess individual patient risk factors and pla n a program for risk factor behaviour change. Each patient received a risk factor assessment, education materials, a series of videos to wat ch on lifestyle behaviours and some patients received a self-help book let. Eighty-two general practitioners were randomised from 75 general practices in Sydney's Western Metropolitan Region to (i) routine care (n = 25), (ii) video group (n = 29) or (iii) video + self help group ( n = 28). GPs enrolled patients into the trial who met selection criter ia for being at risk of CVD. There were 255 patients in the routine ca rl (control) group, 270 in the video (intervention) group and 232 in t he video + self help (intervention) group enrolled in the trial. Outco me measures included patient risk factor status: blood pressure, body mass index, cholesterol and smoking status at entry to trial and after 1 year. Changes in risk factors were used to estimate quality adjuste d life years (QALYs) gained, One hundred and thirty patients in the ro utine care group, 199 in the video group and 155 in the video + self h elp group remained in the trial at the 12-month review and had complet e data. The cost per QALY for males ranged from $AUD152000 to 204000. Further analysis suggests that a program targeted at 'high risk' males would cost approximately $30000 per QALY. The lifestyle interventions had no significant effect on cardiovascular risk factors when compare d to routine patient care. There remains insufficient evidence that li festyle programs conducted in general practices are effective. Resourc es for general practice-based lifestyle programs may be better spent o n high risk patients who are contemplating changes in risk factor beha viours. (C) 1997 Elsevier Science Ireland Ltd.