TY - JOUR
T1 - Cost-effectiveness analysis of a school- and community-based intervention to promote a healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe
T2 - the Feel4Diabetes-study
AU - Willems, Ruben
AU - Tsoutsoulopoulou, Konstantina
AU - Brondeel, Ruben
AU - Cardon, Greet
AU - Makrilakis, Konstantinos
AU - Liatis, Stavros
AU - Lindström, Jaana
AU - Kivelä, Jemina
AU - González-Gil, Esther M
AU - Giménez-Legarre, Natalia
AU - Usheva, Natalya
AU - Iotova, Violeta
AU - Tankova, Tsvetalina
AU - Antal, Emese
AU - Rurik, Imre
AU - Timpel, Patrick
AU - Schwarz, Peter E H
AU - Manios, Yannis
AU - Annemans, Lieven
N1 - Copyright © 2021 Elsevier Inc. All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - The Feel4Diabetes-study implemented a school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes mellitus (T2DM) in six European countries. The intervention included a special focus on families at increased T2DM risk. The current study evaluates the intervention's cost-effectiveness. A Markov-type health economic model was developed to predict the incidence of T2DM and its complications. Incremental cost-effectiveness ratios (lifetime horizon, societal perspective) were calculated based on the overall intervention effect on health behaviour, and stratified for low- and high-risk families. Sensitivity analyses captured input parameters uncertainty. A budget impact analysis was performed. The increase in children's water consumption and physical activity led to a modest gain in quality adjusted life years (QALYs) at a low intervention cost and budget impact. Medical cost savings due to avoided illness could only be achieved on the very long-term (>30 years). The intervention in its entirety was cost-effective (more QALYs at a reasonable investment) in Belgium, Finland, Bulgaria, and Hungary, while being dominant (net savings and more QALYs) in Greece and Spain. Results were cost-effective for the low-risk families, who only received the school- and community-based intervention component. Results for the high-risk families were only cost-effective (with considerable uncertainty) in Greece and Spain, but not when the intervention would need to be repeated. The Feel4Diabetes-intervention is potentially cost-effective, especially in countries with a high overweight and obesity prevalence, at a limited budget impact. The incremental financial investments to reach and support high-risk families did not result in the hoped-for health benefits.
AB - The Feel4Diabetes-study implemented a school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes mellitus (T2DM) in six European countries. The intervention included a special focus on families at increased T2DM risk. The current study evaluates the intervention's cost-effectiveness. A Markov-type health economic model was developed to predict the incidence of T2DM and its complications. Incremental cost-effectiveness ratios (lifetime horizon, societal perspective) were calculated based on the overall intervention effect on health behaviour, and stratified for low- and high-risk families. Sensitivity analyses captured input parameters uncertainty. A budget impact analysis was performed. The increase in children's water consumption and physical activity led to a modest gain in quality adjusted life years (QALYs) at a low intervention cost and budget impact. Medical cost savings due to avoided illness could only be achieved on the very long-term (>30 years). The intervention in its entirety was cost-effective (more QALYs at a reasonable investment) in Belgium, Finland, Bulgaria, and Hungary, while being dominant (net savings and more QALYs) in Greece and Spain. Results were cost-effective for the low-risk families, who only received the school- and community-based intervention component. Results for the high-risk families were only cost-effective (with considerable uncertainty) in Greece and Spain, but not when the intervention would need to be repeated. The Feel4Diabetes-intervention is potentially cost-effective, especially in countries with a high overweight and obesity prevalence, at a limited budget impact. The incremental financial investments to reach and support high-risk families did not result in the hoped-for health benefits.
KW - Diabetes
KW - Health economics
KW - High-risk families
KW - Prevention
UR - http://www.scopus.com/inward/record.url?scp=85111745745&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2021.106722
DO - 10.1016/j.ypmed.2021.106722
M3 - Article
C2 - 34271077
SN - 0091-7435
VL - 153
JO - Preventive Medicine
JF - Preventive Medicine
M1 - 106722
ER -