Use the Back button in your browser to see the other results of your search or to select another record.

Detailed Search Results

Cost-effectiveness of a coronary heart disease secondary prevention program in patients with myocardial infarction: results from a randomised controlled trial (ProActive Heart)
Turkstra E, Hawkes AL, Oldenburg B, Scuffham PA
BMC Cardiovascular Disorders 2013 May 1;13(33):Epub
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Participation in coronary heart disease (CHD) secondary prevention programs is low. Telephone-delivered CHD secondary prevention programs may overcome the treatment gap. The telephone-based health coaching ProActive Heart trial intervention has previously been shown to be effective for improving health-related quality of life, physical activity, body mass index, diet, alcohol intake and anxiety. As a secondary aim, the current study evaluated the cost-effectiveness of the ProActive Heart intervention compared to usual care. METHODS: 430 adult myocardial infarction patients were randomised to a six-month CHD secondary prevention 'health coaching' intervention or 'usual care' control group. Primary outcome variables were health-related quality of life (SF-36) and physical activity (Active Australia Survey). Data were collected at baseline, six-months (post-intervention) and 12 months (six-months post-intervention completion) for longer term effects. Cost-effectiveness data (health utility (SF-6D) and health care utilisation) were collected using self-reported (general practitioner, specialist, other health professionals, health services, and medication) and claims data (hospitalisation rates). Intervention effects are presented as mean differences (95% CI), p-value. RESULTS: Improvements in health status (SF-6D) were observed in both groups, with no significant difference between the groups at six (0.012 (-0.016 to 0.041), p = 0.372) or 12 months (0.011 (-0.028 to 0.051) p = 0.738). Patients in the health coaching group were significantly more likely to be admitted to hospital due to causes unrelated to cardiovascular disease (p = 0.042). The overall cost for the health coaching group was higher ($10,574 versus $8,534, p = 0.021), mainly due to higher hospitalisation (both CHD and non-CHD) costs ($6,841 versus $4,984, p = 0.036). The incremental cost-effectiveness ratio was $85,423 per QALY. CONCLUSIONS: There was no intervention effect measured using the SF-36/SF-6D and ProActive Heart resulted in significantly increased costs. The cost per QALY gained from ProActive Heart was high and above acceptable limits compared to usual care.

Full text (sometimes free) may be available at these link(s):      help