Cost-effectiveness and budget impact of a lifestyle intervention to improve cardiometabolic health in patients with severe mental illness

Abstract

Methods: Patients (n = 244) were randomized to receive either care-as-usual or a lifestyle intervention in which mental health nurses coached patients in changing their lifestyle by using a web tool. Costs and quality of life were assessed at baseline and at 6 and 12 months. Incremental costs per centimeter waist circumference (WC) lost and per Quality-Adjusted Life Year (QALY) gained were assessed. Budget impact was estimated based on three intervention-uptake scenarios using a societal and a third-party payer perspective.
 Results: Costs and reduction in WC were higher in the intervention (n = 114) than in the control (n = 94) group after 12 months, although not statistically significant, resulting in €1,370 per cm WC lost. QALYs did not differ between the groups, resulting in a low probability of the intervention being cost-effective in cost/QALY gained. The budget impact analysis showed that for a reasonable participation of 43%, total costs were around €81 million over 5 years, or on average €16 million annually (societal perspective).
 Conclusions: The intervention is not cost-effective at 12 months and the budget impact over 5 years is substantial. Possibly, 12 months was too short to implement the intervention, improve cardiometabolic health, and reduce care costs. Therefore, the incentive for this intervention cannot be found in short-term financial advantages. However, there may be benefits associated with lifestyle interventions in the long term that remain unclear.

The SMILE lifestyle intervention for people with a severe mental illness: feasibility and (cost-)effectiveness

“…This is also in line with the publications of the STRIDE study (90). Moreover, a Dutch lifestyle study performed in a similar setting as the SMILE study (the LION study), also reported that some clients may need more support than others (82). This emphasizes and confirms the importance of tailoring a lifestyle intervention in this diverse population (90,93).…”

“…Policy makers can use the information on effectiveness and cost-effectiveness in decision-making, i.e., to decide whether it is worthwhile implementing the intervention in routine practice. This is specially of value as cost-effectiveness studies in this population are currently lacking (41,191). In our study, the intervention was costeffective for the body weight change outcome (-3.8kg; 95% CI -6.30 ; -1.23), as there were lower overall costs and people in the intervention group lost more weight than in the control group.…”

“…Organizational determinants related to the implementation and maintenance of a lifestyle intervention have previously been described as being predictive for its success (93,99,104). As previous studies have already suggested, there is a need for mental healthcare organizations to actively put the subject of lifestyle on the agenda and facilitate time and resources to enable sustainable implementation (82).…”

“…To support decision-making in implementing lifestyle interventions, costeffectiveness evaluations are essential and, although a few studies have reported on these in mental health care, evidence is still scarce (40)(41)(42)(43)(44)(45). We therefore also conducted an economic evaluation alongside the trial investigating the costeffectiveness and cost-utility of the SMILE intervention with respect to usual care.…”

“…Several studies have addressed these modifiable cardiovascular risk factors in people with SMI in order to improve physical health and life expectancy (57,80). However, there is still a gap between the available evidence regarding lifestyle interventions and the actual use of lifestyle interventions in daily practice (80)(81)(82). To date, regular mental healthcare still lacks attention regarding lifestyle promotion, even though its importance has been recognized for decades (83).…”