Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial

Jordi Piera-Jiménez, Marjolein Winters, Eva Broers, Damià Valero-Bover, Mirela Habibovic, Jos W M G Widdershoven, Frans Folkvord, Francisco Lupiáñez-Villanueva, Jordi Piera-Jiménez, Marjolein Winters, Eva Broers, Damià Valero-Bover, Mirela Habibovic, Jos W M G Widdershoven, Frans Folkvord, Francisco Lupiáñez-Villanueva

Abstract

Background: During the last few decades, preventing the development of cardiovascular disease has become a mainstay for reducing cardiovascular morbidity and mortality. It has been suggested that interventions should focus more on committed approaches of self-care, such as electronic health techniques.

Objective: This study aimed to provide evidence to understand the financial consequences of implementing the "Do Cardiac Health: Advanced New Generation Ecosystem" (Do CHANGE 2) intervention, which was evaluated in a multisite randomized controlled trial to change the health behavior of patients with cardiovascular disease.

Methods: The cost-effectiveness analysis of the Do CHANGE 2 intervention was performed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing tool, based on a Markov model of five health states. The following two types of costs were considered for both study groups: (1) health care costs (ie, costs associated with the time spent by health care professionals on service provision, including consultations, and associated unplanned hospitalizations, etc) and (2) societal costs (ie, costs attributed to the time spent by patients and informal caregivers on care activities).

Results: The Do CHANGE 2 intervention was less costly in Spain (incremental cost was -€2514.90) and more costly in the Netherlands and Taiwan (incremental costs were €1373.59 and €1062.54, respectively). Compared with treatment as usual, the effectiveness of the Do CHANGE 2 program in terms of an increase in quality-adjusted life-year gains was slightly higher in the Netherlands and lower in Spain and Taiwan.

Conclusions: In general, we found that the incremental cost-effectiveness ratio strongly varied depending on the country where the intervention was applied. The Do CHANGE 2 intervention showed a positive cost-effectiveness ratio only when implemented in Spain, indicating that it saved financial costs in relation to the effect of the intervention.

Trial registration: ClinicalTrials.gov NCT03178305; https://ichgcp.net/clinical-trials-registry/NCT03178305.

Keywords: RCT; behavior change; cardiovascular disease; cost-effectiveness; digital health; eHealth; engagement; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: None declared.

©Jordi Piera-Jiménez, Marjolein Winters, Eva Broers, Damià Valero-Bover, Mirela Habibovic, Jos W M G Widdershoven, Frans Folkvord, Francisco Lupiáñez-Villanueva. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.07.2020.

Figures

Figure 1
Figure 1
Do CHANGE 1 and 2 randomized controlled trial design including intervention details. Do CHANGE: Do Cardiac Health: Advanced New Generation Ecosystem; DSD: Do Something Different; HF: heart failure.
Figure 2
Figure 2
Markov model of five health states applied for the Do CHANGE cost-effectiveness analysis. Do CHANGE: Do Cardiac Health: Advanced New Generation Ecosystem.
Figure 3
Figure 3
Flow chart of participant recruitment (aggregated numbers for Spain, the Netherlands, and Taiwan).
Figure 4
Figure 4
Cost-effectiveness plane for the Do CHANGE intervention in Spain, the Netherlands, and Taiwan. The dotted line shows the willingness-to-pay threshold of €15,000 per QALY. Do CHANGE: Do Cardiac Health: Advanced New Generation Ecosystem; ICER: incremental cost-effectiveness ratio; QALY: quality-adjusted life-year; WTP: willingness to pay.

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