Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 9, 2019
Date Accepted: Jun 3, 2020
Changing Health Behavior of Patients with Cardiovascular Disease Through an eHealth Intervention in Three Different Countries: Cost-Effectiveness Assessment of the Do CHANGE 2 Randomized Controlled Trial
ABSTRACT
Background:
During the last decades, preventing the development of cardiovascular disease has become a mainstay for reducing cardiovascular morbidity and mortality. It has been suggested that interventions should focus more on committed approaches of self-care, such as eHealth techniques.
Objective:
This study aims to provide evidence to understand the financial consequences of implementing the ‘Do Cardiac Health: Advanced New Generation Ecosystem’ intervention (Do CHANGE 2), intervention, evaluated in a multi-site randomized controlled trial to change health behavior in patients with cardiovascular diseases.
Methods:
The cost-effectiveness analysis of the Do CHANGE 2 intervention was assessed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool, based on a Markov model of five health states. Two type of costs were considered for both study groups: (1) healthcare costs (i.e., costs associated with the time spent by healthcare professionals on service provision, including consultations, and those associated unplanned hospitalizations, etc.), and (2) societal costs (i.e., attributed to time spent by patients and informal on care activities).
Results:
The Do CHANGE 2 intervention was less costly in Spain (incremental costs -2,514.90 €) and more costly in the Netherlands and Taiwan (incremental costs were 1,373.59 €, and 1,062.54 €, respectively). Compared with treatment as usual, the effectiveness of the Do CHANGE 2 program in terms of an increase in quality-adjusted life-year (QALY) gains was slightly higher in the Netherlands and lower in Spain and Taiwan.
Conclusions:
In general, we found that the incremental cost-effectiveness ratio strongly varied depending on the country where the intervention was applied. The Do CHANGE 2 intervention showed a positive cost-effectiveness ration only when implemented in Spain, meaning that it saved financial costs in relation to the effect of the intervention. Clinical Trial: ClinicalTrials.gov NCT03178305
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