Cost-Effectiveness of a Peer and Practice Staff Support Intervention | Page 4
Published Online: March 20, 2014
Christopher S. Hollenbeak, PhD; Mark G. Weiner, MD; and Barbara J. Turner, MD, MSED
The threat of CHD looms large worldwide. A modeling analysis of the benefit of interventions to reduce this threat internationally found that targeting interventions to persons whose 10-year CHD risk is over 35% would avert 63 million disability-adjusted life-years worldwide.15 In our trial, participants had a 6-month risk of CHD of roughly 0.63%, which would likely be under that very strict threshold. We suggest that developed nations must consider supporting behavioral interventions that complement pharmacotherapy to reduce risk factors for CHD.
Author Affiliations: Departments of Surgery and Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA (CSH); AstraZeneca Pharmaceuticals, 1800 Concord Pike CIC-523, Wilmington, DE (MGW); Department of Research, University of Texas Health Science Center, San Antonio and University Health System, San Antonio, TX (BJT).
Source of Funding: This study was funded by the Robert Wood Johnson Foundation. In addition, Pfizer contributed supplemental funding for the study. Drs Hollenbeak, Weiner, and Turner received salary support from these funds to complete the work.
Author Disclosures: Dr Hollenbeak reports receiving a grant from the Robert Wood Johnson Foundation, which funded this study. The other authors (MGW, BJT) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (CSH, MGW); acquisition of data (JHN, MGW); analysis and interpretation of data (CSH); drafting of the manuscript (CSH); critical revision of the manuscript for important intellectual content (CSH, MGW); statistical analysis (CSH); administrative, technical, or logistic support (CSH).
Address correspondence to: Barbara J. Turner, MD, MSEd, REACH Center, University of Texas Health Science Center, 1 Technology Center, 7411 John Smith Drive, Ste 1100, San Antonio, TX 78229. E-mail: turner @uthscsa.edu.
1. Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the Chronic Care Model in the new millennium. Health Aff (Millwood). 2009;28(1): 75-85.
2. Gilmer TP, O’Connor PJ, Rush WA, et al. Impact of office systems and improvement strategies on costs of care for adults with diabetes. Diabetes Care. 2006;29(6):1242-1248.
3. Schouten LM, Niessen LW, van de Pas JW, Grol RP, Hulscher ME. Cost-effectiveness of a quality improvement collaborative focusing on patients with diabetes. Med Care. 2010;48(10):884-891.
4. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-1252.
5. D’Agostino RB, Russell MW, Huse DM, et al. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J. 2000;139(2, pt 1):272-281.
6. Neumann PJ, Johannesson M. From principle to public policy: using cost-effectiveness analysis. Health Aff (Millwood). 1994;13(3):206-214.
7. Hollenbeak CS, Dillon PW. An introduction to economic evaluation for pediatric surgeons. Semin Pediatr Surg. 2002;11(1):55-59.
8. Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ. 1997;6(4):327-340.
9. Chaudhary MA, Stearns SC. Estimating confidence intervals for costeffectiveness ratios: an example from a randomized trial. Stat Med. 1996; 15(13):1447-1458.
10. Lothgren M, Zethraeus N. Definition, interpretation and calculation of cost-effectiveness acceptability curves. Health Econ. 2000;9(7): 623-630.
11. Baker TM, Goh J, Johnston A, Falvey H, Brede Y, Brown RE. Costeffectiveness analysis of valsartan versus losartan and the effect of switching. J Med Econ. 2012;15(2):253-260.
12. Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991;121(1, pt 2):293-298.
13. Sullivan PW, Ghushchyan V. Preference-Based EQ-5D index scores for chronic conditions in the United States. Med Decis Making. 2006; 26(4):410-420.
14. Currie CJ, McEwan P, Peters JR, Patel TC, Dixon S. The routine collation of health outcomes data from hospital treated subjects in the Health Outcomes Data Repository (HODaR): descriptive analysis from the first 20,000 subjects. Value Health. 2005;8(5):581-590.
15. Barton P, Andronis L, Briggs A, McPherson K, Capewell S. Effectiveness and cost-effectiveness of cardiovascular disease prevention in whole populations: modelling study. BMJ. 2011;343:d4044.
16. Barg FK, Weiner MG, Joseph S, Pandit K, Turner BJ. Qualitative analysis of peer coaches’ experiences with counseling African Americans about reducing heart disease risk. J Intern Med. In press.
17. Graves N, Barnett AG, Halton KA, et al. Cost-effectiveness of a telephone-delivered intervention for physical activity and diet. PLoS One. 2009;4(9):e7135.
18. Barton GR, Goodall M, Bower P, Woolf S, Capewell S, Gabbay MB. Increasing heart-health lifestyles in deprived communities: economic evaluation of lay health trainers. J Eval Clin Pract. 2012;18(4):835-840.
19. Chapman RH, Kowal SL, Cherry SB, Ferrufino CP, Roberts CS, Chen L. The modeled lifetime cost-effectiveness of published adherenceimproving interventions for antihypertensive and lipid-lowering medications. Value Health. 2010;13(6):685-694.
20. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18-e209.
21. Finkelstein EA, Khavjou O, Will JC. Cost-effectiveness of WISEWOMAN, a program aimed at reducing heart disease risk among lowincome women. J Womens Health (Larchmt). 2006;15(4):379-389.
22. Murray CJ, Lauer JA, Hutubessy RC, et al. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet. 2003;361(9359):717-725.