Economic Evaluation of a Web-Based Tailored Lifestyle Intervention for Adults: Findings Regarding Cost-Effectiveness and Cost-Utility From a Randomized Controlled Trial

Background

Different studies have reported the effectiveness of Web-based computer-tailored lifestyle interventions, but economic evaluations of these interventions are scarce.

Objective

The objective was to assess the cost-effectiveness and cost-utility of a sequential and a simultaneous Web-based computer-tailored lifestyle intervention for adults compared to a control group.

Methods

The economic evaluation, conducted from a societal perspective, was part of a 2-year randomized controlled trial including 3 study groups. All groups received personalized health risk appraisals based on the guidelines for physical activity, fruit intake, vegetable intake, alcohol consumption, and smoking. Additionally, respondents in the sequential condition received personal advice about one lifestyle behavior in the first year and a second behavior in the second year; respondents in the simultaneous condition received personal advice about all unhealthy behaviors in both years. During a period of 24 months, health care use, medication use, absenteeism from work, and quality of life (EQ-5D-3L) were assessed every 3 months using Web-based questionnaires. Demographics were assessed at baseline, and lifestyle behaviors were assessed at both baseline and after 24 months. Cost-effectiveness and cost-utility analyses were performed based on the outcome measures lifestyle factor (the number of guidelines respondents adhered to) and quality of life, respectively. We accounted for uncertainty by using bootstrapping techniques and sensitivity analyses.

Results

A total of 1733 respondents were included in the analyses. From a willingness to pay of €4594 per additional guideline met, the sequential intervention (n=552) was likely to be the most cost-effective, whereas from a willingness to pay of €10,850, the simultaneous intervention (n=517) was likely to be most cost-effective. The control condition (n=664) appeared to be preferred with regard to quality of life.

Conclusions

Both the sequential and the simultaneous lifestyle interventions were likely to be cost-effective when it concerned the lifestyle factor, whereas the control condition was when it concerned quality of life. However, there is no accepted cutoff point for the willingness to pay per gain in lifestyle behaviors, making it impossible to draw firm conclusions. Further economic evaluations of lifestyle interventions are needed.

Trial Registration

Dutch Trial Register NTR2168; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2168 (Archived by WebCite at http://www.webcitation.org/6MbUqttYB).     

Postoperative hypertension after repair of coarctation of aorta in children: protective effect of propranolol?

The effects of the nonselective beta blocker, propranolol, on coarctectomy-induced hypertension were evaluated relative to changes in cardiac function, sympathetic tone, and plasma renin activity (PRA). A randomized, placebo-controlled, double-blind, age-stratified design was employed. Propranolol (n = 11, mean age 9.4 years) or placebo (n = 12, mean age 10.2 years) was started 2 days before surgery and continued until 6 days after surgery. In patients on placebo, systolic and diastolic blood pressure, heart rate, and cardiac index increased rapidly and peaked within 1 day after surgery. Over the ensuing days these increases gradually abated. Plasma epinephrine and PRA increased markedly within 12 hours after surgery, but returned quickly toward preoperative levels. In contrast, plasma norepinephrine increased more gradually and remained elevated longer. In patients on propranolol, systolic blood pressure, heart rate, cardiac index and PRA showed only negligible increases. However, diastolic blood pressure, increased even faster with propranolol than with placebo but to the same extent. Plasma catecholamines showed similar increases on the two treatments. Only in the placebo group was the code broken in the intensive care unit because of hypertension uncontrolled by sodium nitroprusside; this occurred in 6 of 12 patients. We conclude that nonselective beta blockade ameliorates the hyperdynamic circulation and increase in systolic blood pressure following coarctectomy. The initial increase in diastolic blood pressure following surgery in the propranolol group may have been caused by vascular beta-2-receptor blockade resulting in unopposed alpha-receptor-mediated vasoconstriction.     

Voluntary alcohol intake is attenuated in two-kidney, one-clip, but not in one-kidney, one-clip Goldblatt hypertensive rats

Voluntary alcohol intake was examined in two models of renovascular hypertension known to differ in their effects on the renin-angiotensin system. In experiment 1, Two-Kidney, One-Clip (renin-dependent) hypertensive rats (T-K,O-C) or their sham operated controls were offered limited access to alcohol for 1 hr each day. Over a four week period the T-K,O-C rats drank significantly less 3% and 6% (w/v) alcohol solution than the sham operated controls. In experiment 2, One-Kidney, One-Clip (renin-independent) hypertensive rats or their sham operated controls were offered alcohol on a similar limited access basis. Over a four week period, the O-K,O-C rats did not show a reduction in the intake of either a 3% or 6% alcohol solution compared to the sham operated controls. These results provide further documentation for the role of the renin-angiotensin system in modulating alcohol intake. The process by which this system might influence alcohol intake is outlined.     

Vagus nerve stimulation has a positive effect on mood in patients with refractory epilepsy

Background

Preliminary research on the efficacy of vagus nerve stimulation (VNS) indicated additional effects on neuropsychological variables like mood and quality of life (QOL).

Objectives

The objectives of this prospective longitudinal observational cohort study were to assess the effects of VNS on mood, QOL and cognition in patients with refractory epilepsy and to determine whether these effects occur dependent of seizure control.

Methods

We included 41 patients with refractory epilepsy; treated with VNS as part of usual patient care. A neuropsychological battery was performed during baseline and repeated after 6 months of VNS in order to compare neuropsychological variables before and after VNS. All patients completed seizure diaries.

Results

Significant improvements were observed for both mood and QOL after 6 months of VNS; based on the results in the POMS and QOLIE-89 questionnaires (p < 0.05). There was no significant change in cognition. Mean percentage change in seizure frequency was −9.0%, while 20% of the patients achieved a seizure frequency reduction of 50% or more. No significant correlation was found between changes in seizure frequency and improvements in mood or QOL.

Conclusions

VNS is associated with improvements in both mood and QOL in patients with refractory epilepsy. Since these improvements appeared to be independent of seizure control, the results of this study indicate an additional antidepressant effect of VNS, which can be of extra value in view of the high co-morbidity of mood disturbances in patients with epilepsy.     

Construction of modern Australian first trimester ultrasound dating and growth charts

Accurate pregnancy dating is vital to obstetric management. However, first trimester fetal charts commonly used in Australia rely on data reported more than three decades ago. This study reports first trimester dating and growth charts for crown‐rump length between 5 and 14 weeks of gestation and biparietal diameter between 9 and 14 weeks of gestation on an Australia population using modern real‐time ultrasound equipment. All consenting eligible women attending a large Sydney clinic for first trimester ultrasound between March 2005 and December 2006 were recruited. Measurements were carried out to Australasian Society for Ultrasound in Medicine standard protocols. Statistical analyses were undertaken using polynomial regression models and thorough diagnostic checks made. Overall 396 eligible women consented to the study, with 268 between 9 and 14 weeks of gestation. The average participant age was 34 years (range 22–45 years), 371 and all yielded valid biometry measurements. Equations, means and 90% reference intervals for crown‐rump length measurements and biparietal diameter measurements were derived using polynomial regression models. Thorough residual and diagnostic checks were made. Once validated by others, we believe they will warrant consideration for use by Australasian Society for Ultrasound in Medicine.