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BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Cost-effectiveness of health promotion targeting physical activity and healthy eating in mental health care

Authors: Nick Verhaeghe, Delphine De Smedt, Jan De Maeseneer, Lea Maes, Cornelis Van Heeringen, Lieven Annemans

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

There is a higher prevalence of obesity in individuals with mental disorders compared to the general population. The results of several studies suggested that weight reduction in this population is possible following psycho-educational and/or behavioural weight management interventions. Evidence of the effectiveness alone is however inadequate for policy making. The aim of the current study was to evaluate the cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders.

Methods

A Markov decision-analytic model using a public payer perspective was applied, projecting the one-year results of a 10-week intervention over a time horizon of 20 years, assuming a repeated yearly implementation of the programme. Scenario analysis was applied evaluating the effects on the results of alternative modelling assumptions. One-way sensitivity analysis was performed to assess the effects on the results of varying key input parameters.

Results

An incremental cost-effectiveness ratio of 27,096€/quality-adjusted life years (QALY) in men, and 40,139€/QALY in women was found in the base case. Scenario analysis assuming an increase in health-related quality of life as a result of the body mass index decrease resulted in much better cost-effectiveness in both men (3,357€/QALY) and women (3,766€/QALY). The uncertainty associated with the intervention effect had the greatest impact on the model.

Conclusions

As far as is known to the authors, this is the first health economic evaluation of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders. Such research is important as it provides payers and governments with better insights how to spend the available resources in the most efficient way. Further research examining the cost-effectiveness of health promotion targeting physical activity and healthy eating in individuals with mental disorders is required.
Appendix
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Literature
1.
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M: National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011, 377: 557-567. 10.1016/S0140-6736(10)62037-5.CrossRefPubMedPubMedCentral
2.
3.
Muller-Riemenschneider F, Reinhold T, Berghofer A, Willich SN: Health-economic burden of obesity in Europe. Eur J Epidemiol. 2008, 23: 499-509. 10.1007/s10654-008-9239-1.CrossRefPubMed
4.
Ul-Haq Z, Mackay DF, Pell JP: Meta-analysis of the association between body mass index and health-related quality of life among adults, assessed by the SF-36. Obesity. 2013, 21: E322-E327. 10.1002/oby.20107.CrossRefPubMed
5.
Dixon JB: The effect of obesity on health outcomes. Mol Cell Endocrinol. 2010, 316: 104-108. 10.1016/j.mce.2009.07.008.CrossRefPubMed
6.
Allison DB, Newcomer JW, Dunn AL, Blumenthal JA, Fabricatore AN, Daumit GL, Cope MB, Riley WT, Vreeland B, Hibbeln JR, Alpert JE: Obesity among those with mental disorders: a National Institute of Mental Health meeting report. Am J Prev Med. 2009, 36: 341-350. 10.1016/j.amepre.2008.11.020.CrossRefPubMed
7.
Mackin P, Bishop D, Watkinson H, Gallagher P, Ferrier IN: Metabolic disease and cardiovascular risk in people treated with antipsychotics in the community. Br J Psychiatry. 2007, 191: 23-29. 10.1192/bjp.bp.106.031716.CrossRefPubMed
8.
Parsons B, Allison DB, Loebel A, Williams K, Giller E, Romano S, Siu C: Weight effects associated with antipsychotics: a comprehensive database analysis. Schizophr Res. 2009, 110: 103-110. 10.1016/j.schres.2008.09.025.CrossRefPubMed
9.
Osborn DP, Nazareth I, King MB: Physical activity, dietary habits and Coronary Heart Disease risk factor knowledge amongst people with severe mental illness: a cross sectional comparative study in primary care. Soc Psychiatry Psychiatr Epidemiol. 2007, 42: 787-793. 10.1007/s00127-007-0247-3.CrossRefPubMed
10.
Ball MP, Coons VB, Buchanan RW: A program for treating olanzapine-related weight gain. Psychiatr Serv. 2001, 52: 967-969. 10.1176/appi.ps.52.7.967.CrossRefPubMed
11.
Mauri M, Simoncini M, Castrogiovanni S, Iovieno N, Cecconi D, Dell’Agnello G, Quadrigli M, Rossi A, Donda P, Fagiolini P, Cassano GB: A psychoeducational program for weight loss in patients who have experienced weight gain during antipsychotic treatment with olanzapine. Pharmacopsychiatry. 2008, 41: 17-23. 10.1055/s-2007-992148.CrossRefPubMed
12.
Garrett S, Elley CR, Rose SB, O’Dea D, Lawton BA, Dowell AC: Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence. Br J Gen Pract. 2011, 61: e125-e133. 10.3399/bjgp11X561249.CrossRefPubMedPubMedCentral
13.
van Baal PH, van den Berg M, Hoogenveen RT, Vijgen SM, Engelfriet PM: Cost-effectiveness of a low-calorie diet and orlistat for obese persons: modeling long-term health gains through prevention of obesity-related chronic diseases. Value Health. 2008, 11: 1033-1040. 10.1111/j.1524-4733.2008.00328.x.CrossRefPubMed
14.
Verhaeghe N, De MJ, Maes L, Van HC, Annemans L: Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review. Int J Behav Nutr Phys Act. 2011, 8: 28-10.1186/1479-5868-8-28.CrossRefPubMedPubMedCentral
15.
Verhaeghe N, Clays E, Vereecken C, De Maeseneer J, Maes L, Van Heeringen C, De Bacquer D, Annemans L: Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial. BMC Public Health. 2013, 13: 657-10.1186/1471-2458-13-657.CrossRefPubMedPubMedCentral
16.
17.
De Smedt D, De Cocker K, Annemans L, De Bourdeaudhuij I, Cardon G: A cost-effectiveness study of the community-based intervention ‘10 000 Steps Ghent’. Public Health Nutr. 2012, 15: 442-451. 10.1017/S1368980011001716.CrossRefPubMed
18.
19.
20.
21.
22.
Truyers C, Buntinx F, De LJ, De HM, van Winkel R, Aertgeerts B, Bartholomeeusen S, Lesaffre E: Incident somatic comorbidity after psychosis: results from a retrospective cohort study based on Flemish general practice data. BMC Fam Pract. 2011, 12: 132-10.1186/1471-2296-12-132.CrossRefPubMedPubMedCentral
23.
Osborn DP, Levy G, Nazareth I, Petersen I, Islam A, King MB: Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s General Practice Rsearch Database. Arch Gen Psychiatry. 2007, 64: 242-249. 10.1001/archpsyc.64.2.242.CrossRefPubMed
24.
Hippisley-Cox J, Vinogradova Y, Coupland C, Parker C: Risk of malignancy in patients with schizophrenia or bipolar disorder: nested case-control study. Arch Gen Psychiatry. 2007, 64: 1368-1376. 10.1001/archpsyc.64.12.1368.CrossRefPubMed
25.
Larsson SC, Orsini N, Wolk A: Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005, 97: 1679-1687. 10.1093/jnci/dji375.CrossRefPubMed
26.
27.
Ubink-Veltmaat LJ, Bilo HJ, Groenier KH, Houweling ST, Rischen RO, Meyboom-de JB: Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in The Netherlands (ZODIAC-1). Eur J Epidemiol. 2003, 18: 793-800.CrossRefPubMed
28.
Vaartjes I, van Dis I, Grobbee DE, Bots ML: The dynamics of mortality in follow-up time after an acute myocardial infarction, lower extremity arterial disease and ischemic stroke. BMC Cardiovasc Disord. 2010, 10: 57-10.1186/1471-2261-10-57.CrossRefPubMedPubMedCentral
29.
Belgian Cancer Registry: Cancer Survival in Belgium 2004-2008. 2012, Brussels: Belgian Cancer Registry
30.
Schienkiewitz A, Schulze MB, Hoffmann K, Kroke A, Boeing H: Body mass index history and risk of type 2 diabetes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Am J Clin Nutr. 2006, 84: 427-433.PubMed
31.
McGee DL: Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol. 2005, 15: 87-97. 10.1016/j.annepidem.2004.05.012.CrossRefPubMed
32.
Kurth T, Gaziano JM, Berger K, Kase CS, Rexrode KM, Cook NR, Buring JE, Manson JE: Body mass index and the risk of stroke in men. Arch Intern Med. 2002, 162: 2557-2562. 10.1001/archinte.162.22.2557.CrossRefPubMed
33.
Rosengren A, Wilhelmsen L, Lappas G, Johansson S: Body mass index, coronary heart disease and stroke in Swedish women. A prospective 19-year follow-up in the BEDA study. Eur J Cardiovasc Prev Rehabil. 2003, 10: 443-450. 10.1097/01.hjr.0000085253.65733.ef.CrossRefPubMed
34.
Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M: Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008, 371: 569-578. 10.1016/S0140-6736(08)60269-X.CrossRefPubMed
35.
Williams R, Van GL, Lucioni C: Assessing the impact of complications on the costs of Type II diabetes. Diabetologia. 2002, 45: S13-S17. 10.1007/s00125-002-0859-9.CrossRefPubMed
36.
Annemans L, Lamotte M, Clarys P, Van den Abeele E: Health economic evaluation of controlled and maintained physical exercise in the prevention of cardiovascular and other prosperity diseases. Eur J Cardiovasc Prev Rehabil. 2007, 14: 815-824. 10.1097/HJR.0b013e3282ef514f.CrossRefPubMed
37.
Annemans L, Marbaix S, Webb K, Van GL, Scheen A: Cost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population. Clin Drug Investig. 2010, 30: 133-142. 10.2165/11531910-000000000-00000.CrossRefPubMed
38.
Lamotte M, Caekelbergh K, Annemans L: Assessment of the cost of cardiovascular death. Value Health. 2003, 6: 658-CrossRef
39.
Cleemput I, Crott R, Vrijens F, Huybrechts M, Van Wilder P, Ramaekers D: Voorlopige Richtlijnen voor Farmaco-economisch Onderzoek in België. Health Technology Assessment (HTA), KCE Report 28A (D/2006/10.273/10) edn. 2006, Brussels: Belgian Health Care Knowledge Centre (KCE)
40.
Saarni SI, Viertio S, Perala J, Koskinen S, Lonnqvist J, Suvisaari J: Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders. Br J Psychiatry. 2010, 197: 386-394. 10.1192/bjp.bp.109.076489.CrossRefPubMed
41.
Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes. 2005, Oxford: Oxford University Press, 3
42.
Coffey JT, Brandle M, Zhou H, Marriott D, Burke R, Tabaei BP, Engelgau MM, Kaplan RM, Herman WH: Valuing health-related quality of life in diabetes. Diabetes Care. 2002, 25: 2238-2243. 10.2337/diacare.25.12.2238.CrossRefPubMed
43.
Briggs A, Claxton K, Sculpher M: Decision Modelling for Health Economic Evaluation. 2006, Oxford: Oxford University Press
44.
Cleemput I, Neyt M, Thiry N, De Laet C, Leys M: Threshold Values for Cost-Effectiveness in Health Care. Health Technology Assessment (HTA). KCE Report 100C (D/2008/10.273/96) edn. 2008, Brussels: Belgian Health Care Knowledge Centre (KCE)
45.
McDevitt J, Snyder M, Miller A, Wilbur J: Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation. J Nurs Scholarsh. 2006, 38: 50-55. 10.1111/j.1547-5069.2006.00077.x.CrossRefPubMed
46.
Polsky D, Doshi JA, Bauer MS, Glick HA: Clinical trial-based cost-effectiveness analyses of antipsychotic use. Am J Psychiatry. 2006, 163: 2047-2056. 10.1176/appi.ajp.163.12.2047.CrossRefPubMed
47.
Zechmeister I, Kilian R, McDaid D: Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations. BMC Public Health. 2008, 8: 20-10.1186/1471-2458-8-20.CrossRefPubMedPubMedCentral
48.
Menza M, Vreeland B, Minsky S, Gara M, Radler DR, Sakowitz M: Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program. J Clin Psychiatry. 2004, 65: 471-477.CrossRefPubMed
49.
Unick JL, Beavers D, Bond DS, Clark JM, Jakicic JM, Kitabchi AE, Knowler WC, Wadden TE, Wagenknecht LE, Wing RR: The long-term effectiveness of a lifestyle intervention in severely obese individuals. Am J Med. 2013, 126: 236-242. 10.1016/j.amjmed.2012.10.010.CrossRefPubMedPubMedCentral
50.
Hersey JC, Khavjou O, Strange LB, Atkinson RL, Blair SN, Campbell S, Hobbs CL, Kelly B, Fitzgerald TM, Kish-Doto J, Koch MA, Munoz B, Peele E, Stockdale J, Augustine C, Mitchell G, Arday D, Kugler J, Dorn P, Ellzy J, Julian R, Grissom J, Britt M: The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the health weight management demonstration. Prev Med. 2012, 54: 42-49. 10.1016/j.ypmed.2011.09.018.CrossRefPubMed
51.
Fowler MJ: Microvascular and macrovascular complications of diabetes. Clin Diab. 2008, 26: 77-82. 10.2337/diaclin.26.2.77.CrossRef
52.
van Asselt AD, Dirksen CD, Arntz A, Giesen-Bloo JH, Severens JL: The EQ-5D: A useful quality of life measure in borderline personality disorder?. Eur Psychiatry. 2009, 24: 79-85. 10.1016/j.eurpsy.2008.11.001.CrossRefPubMed
53.
Lamers LM, Bouwmans CA, van Straten A, Donker MC, Hakkaart L: Comparison of EQ-5D and SF-6D utilities in mental health patients. Health Econ. 2006, 15: 1229-1236. 10.1002/hec.1125.CrossRefPubMed
Metadata
Title
Cost-effectiveness of health promotion targeting physical activity and healthy eating in mental health care
Authors
Nick Verhaeghe
Delphine De Smedt
Jan De Maeseneer
Lea Maes
Cornelis Van Heeringen
Lieven Annemans
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-856

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