Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study)

Ignacio Aznar-Lou, Edurne Zabaleta-Del-Olmo, Marc Casajuana-Closas, Alba Sánchez-Viñas, Elizabeth Parody-Rúa, Bonaventura Bolíbar, Montserrat Iracheta-Todó, Oana Bulilete, Tomàs López-Jiménez, Haizea Pombo-Ramos, María Victoria Martín Miguel, Rosa Magallón-Botaya, Jose Ángel Maderuelo-Fernández, Emma Motrico, Juan Bellón, Ruth Martí-Lluch, Maria Rubio-Valera, Antoni Serrano-Blanco, Ignacio Aznar-Lou, Edurne Zabaleta-Del-Olmo, Marc Casajuana-Closas, Alba Sánchez-Viñas, Elizabeth Parody-Rúa, Bonaventura Bolíbar, Montserrat Iracheta-Todó, Oana Bulilete, Tomàs López-Jiménez, Haizea Pombo-Ramos, María Victoria Martín Miguel, Rosa Magallón-Botaya, Jose Ángel Maderuelo-Fernández, Emma Motrico, Juan Bellón, Ruth Martí-Lluch, Maria Rubio-Valera, Antoni Serrano-Blanco

Abstract

Background: Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction.

Methods: An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results.

Results: The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis.

Conclusion: The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects.

Trial registration: Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 - Retrospectively registered.

Keywords: Economic evaluation; Health promotion; Hybrid trial; Primary care.

Conflict of interest statement

Authors declare no conflict of interest. The funding bodies did not play any role in the design of the study and collection, analysis, or interpretation of data and writing.

Figures

Fig. 1
Fig. 1
Flow diagram of clusters and participants through study. PHC, Primary Health Care
Fig. 2
Fig. 2
Cost–utility and cost-effectiveness of EIRA intervention vs usual care

References

    1. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Ackerman IN, Adamu AA, Adebayo OM, Adekanmbi V, Adetokunboh OO, Adib MG, Adsuar JC, Afanvi KA, Afarideh M, Afshin A, Agarwal G, Agesa KM, Aggarwal R, Aghayan SA, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemiju T, Akseer N, al-Aly Z, al-Eyadhy A, al-Mekhlafi HM, al-Raddadi RM, Alahdab F, Alam K, Alam T, Alashi A, Alavian SM, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A', Alla F, Allebeck P, Alouani MML, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Antonio CAT, Anwari P, Arabloo J, Arauz A, Aremu O, Ariani F, Armoon B, Ärnlöv J, Arora A, Artaman A, Aryal KK, Asayesh H, Asghar RJ, Ataro Z, Atre SR, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayer R, Azzopardi PS, Babazadeh A, Badali H, Badawi A, Bali AG, Ballesteros KE, Ballew SH, Banach M, Banoub JAM, Banstola A, Barac A, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Belachew AB, Belay YA, Bell ML, Bello AK, Bensenor IM, Bernabe E, Bernstein RS, Beuran M, Beyranvand T, Bhala N, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Blacker BF, Blyth FM, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brainin M, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko AN, Britton G, Brugha T, Buchbinder R, Busse R, Butt ZA, Cahuana-Hurtado L, Cano J, Cárdenas R, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Cercy KM, Cerin E, Chaiah Y, Chang AR, Chang HY, Chang JC, Charlson FJ, Chattopadhyay A, Chattu VK, Chaturvedi P, Chiang PPC, Chin KL, Chitheer A, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Collado-Mateo D, Cooper C, Coresh J, Cortesi PA, Cortinovis M, Costa M, Cousin E, Criqui MH, Cromwell EA, Cross M, Crump JA, Dadi AF, Dandona L, Dandona R, Dargan PI, Daryani A, Das Gupta R, Das Neves J, Dasa TT, Davey G, Davis AC, Davitoiu DV, de Courten B, de la Hoz FP, de Leo D, de Neve JW, Degefa MG, Degenhardt L, Deiparine S, Dellavalle RP, Demoz GT, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dinberu MT, Dirac MA, Djalalinia S, Doan L, Dokova K, Doku DT, Dorsey ER, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Echko MM, Edvardsson D, Effiong A, Ehrlich JR, el Bcheraoui C, el Sayed Zaki M, el-Khatib Z, Elkout H, Elyazar IRF, Enayati A, Endries AY, Er B, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Esteghamati S, Fakhim H, Fallah Omrani V, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSE, Farioli A, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrari AJ, Feyissa GT, Filip I, Fischer F, Fitzmaurice C, Foigt NA, Foreman KJ, Fox J, Frank TD, Fukumoto T, Fullman N, Fürst T, Furtado JM, Futran ND, Gall S, Ganji M, Gankpe FG, Garcia-Basteiro AL, Gardner WM, Gebre AK, Gebremedhin AT, Gebremichael TG, Gelano TF, Geleijnse JM, Genova-Maleras R, Geramo YCD, Gething PW, Gezae KE, Ghadiri K, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Ghosh R, Ghoshal AG, Giampaoli S, Gill PS, Gill TK, Ginawi IA, Giussani G, Gnedovskaya EV, Goldberg EM, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Gorman TM, Goulart AC, Goulart BNG, Grada A, Grams ME, Grosso G, Gugnani HC, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Haghparast Bidgoli H, Hagos TB, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hawley CN, Hay RJ, Hay SI, Hedayatizadeh-Omran A, Heibati B, Hendrie D, Henok A, Herteliu C, Heydarpour S, Hibstu DT, Hoang HT, Hoek HW, Hoffman HJ, Hole MK, Homaie Rad E, Hoogar P, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huynh CK, Iburg KM, Ikeda CT, Ileanu B, Ilesanmi OS, Iqbal U, Irvani SSN, Irvine CMS, Islam SMS, Islami F, Jacobsen KH, Jahangiry L, Jahanmehr N, Jain SK, Jakovljevic M, Javanbakht M, Jayatilleke AU, Jeemon P, Jha RP, Jha V, Ji JS, Johnson CO, Jonas JB, Jozwiak JJ, Jungari SB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Kanchan T, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kawakami N, Karyani AK, Keighobadi MM, Keiyoro PN, Kemmer L, Kemp GR, Kengne AP, Keren A, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan MS, Khan MA, Khang YH, Khazaei M, Khoja AT, Khosravi A, Khosravi MH, Kiadaliri AA, Kiirithio DN, Kim CI, Kim D, Kim P, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knudsen AKS, Kocarnik JM, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kyu HH, Lad DP, Lad SD, Lafranconi A, Lalloo R, Lallukka T, Lami FH, Lansingh VC, Latifi A, Lau KMM, Lazarus JV, Leasher JL, Ledesma JR, Lee PH, Leigh J, Leung J, Levi M, Lewycka S, Li S, Li Y, Liao Y, Liben ML, Lim LL, Lim SS, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Lucchesi LR, Lunevicius R, Lyons RA, Ma S, Macarayan ERK, Mackay MT, Madotto F, Magdy Abd el Razek H, Magdy Abd el Razek M, Maghavani DP, Mahotra NB, Mai HT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Manhertz T, Mansournia MA, Mantovani LG, Mapoma CC, Maravilla JC, Marcenes W, Marks A, Martins-Melo FR, Martopullo I, März W, Marzan MB, Mashamba-Thompson TP, Massenburg BB, Mathur MR, Matsushita K, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mejia-Rodriguez F, Mekonen T, Melese A, Melku M, Meltzer M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezerji NMG, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miltz B, Mini GK, Mirarefin M, Mirrakhimov EM, Misganaw AT, Mitchell PB, Mitiku H, Moazen B, Mohajer B, Mohammad KA, Mohammadifard N, Mohammadnia-Afrouzi M, Mohammed MA, Mohammed S, Mohebi F, Moitra M, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Moschos MM, Mountjoy-Venning WC, Mousavi SM, Mruts KB, Muche AA, Muchie KF, Mueller UO, Muhammed OS, Mukhopadhyay S, Muller K, Mumford JE, Murhekar M, Musa J, Musa KI, Mustafa G, Nabhan AF, Nagata C, Naghavi M, Naheed A, Nahvijou A, Naik G, Naik N, Najafi F, Naldi L, Nam HS, Nangia V, Nansseu JR, Nascimento BR, Natarajan G, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngunjiri JW, Nguyen AQ, Nguyen HT, Nguyen HLT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen NB, Nguyen SH, Nichols E, Ningrum DNA, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Ong KL, Ong SK, Oren E, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, P A M, Pacella R, Pakpour AH, Pana A, Panda-Jonas S, Parisi A, Park EK, Parry CDH, Patel S, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paulson KR, Pearce N, Pereira DM, Perico N, Pesudovs K, Pham HQ, Phillips MR, Pigott DM, Pillay JD, Piradov MA, Pirsaheb M, Pishgar F, Plana-Ripoll O, Plass D, Polinder S, Popova S, Postma MJ, Pourshams A, Poustchi H, Prabhakaran D, Prakash S, Prakash V, Purcell CA, Purwar MB, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MH, Rahman MA, Rahman SU, Rai RK, Rajati F, Ram U, Ranjan P, Ranta A, Rao PC, Rawaf DL, Rawaf S, Reddy KS, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro ALP, Roberts NLS, Robinson SR, Roever L, Ronfani L, Roshandel G, Rostami A, Roth GA, Roy A, Rubagotti E, Sachdev PS, Sadat N, Saddik B, Sadeghi E, Saeedi Moghaddam S, Safari H, Safari Y, Safari-Faramani R, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salam N, Salama JS, Salamati P, Saleem K, Saleem Z, Salimi Y, Salomon JA, Salvi SS, Salz I, Samy AM, Sanabria J, Sang Y, Santomauro DF, Santos IS, Santos JV, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Saylan M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma M, Sharma R, She J, Sheikh A, Shi P, Shibuya K, Shigematsu M, Shiri R, Shirkoohi R, Shishani K, Shiue I, Shokraneh F, Shoman H, Shrime MG, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silveira DGA, Singam NSV, Singh JA, Singh NP, Singh V, Sinha DN, Skiadaresi E, Slepak ELN, Sliwa K, Smith DL, Smith M, Soares Filho AM, Sobaih BH, Sobhani S, Sobngwi E, Soneji SS, Soofi M, Soosaraei M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein DJ, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Subart ML, Sudaryanto A, Sufiyan M'B, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse BT, Tandon N, Tassew SG, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekalign TG, Tekelemedhin SW, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Teweldemedhin M, Thankappan KR, Thomas N, Tilahun B, To QG, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Troeger CE, Truelsen TC, Tsilimbaris MK, Tsoi D, Tudor Car L, Tuzcu EM, Ukwaja KN, Ullah I, Undurraga EA, Unutzer J, Updike RL, Usman MS, Uthman OA, Vaduganathan M, Vaezi A, Valdez PR, Varughese S, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vosoughi K, Vujcic IS, Wagnew FS, Waheed Y, Waller SG, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weiss DJ, Weldegebreal F, Weldegwergs KG, Werdecker A, West TE, Whiteford HA, Widecka J, Wijeratne T, Wilner LB, Wilson S, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Woolf AD, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang K, Zhao Z, Zhou M, Zodpey S, Zucker I, Vos T, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1789–1858. doi: 10.1016/S0140-6736(18)32279-7.
    1. Cortaredona S, Ventelou B. The extra cost of comorbidity: multiple illnesses and the economic burden of non-communicable diseases. BMC Med. 2017;15:1–11. doi: 10.1186/s12916-017-0978-2.
    1. Scarborough P, Bhatnagar P, Wickramasinghe KK, Allender S, Foster C, Rayner M. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. J Public Health (Bangkok) 2011;33(4):527–535. doi: 10.1093/pubmed/fdr033.
    1. Violán C, Foguet-Boreu Q, Roso-Llorach A, Rodríguez-Blanco T, Pons-Vigués M, Pujol-Ribera E, et al. Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study. BMC Public Health. 2014;14(1):530. doi: 10.1186/1471-2458-14-530.
    1. World Health Organization. Noncommunicable diseases: country profiles 2018. Geneva: World Health Organization; 2018.
    1. Prochaska JJ, Spring B, Nigg CR. Multiple health behavior change research: an introduction and overview. Prev Med (Baltim). 2008;46(3):181–188. doi: 10.1016/j.ypmed.2008.02.001.
    1. McRobbie H, Hajek P, Peerbux S, Kahan BC, Eldridge S, Trépel D, et al. Randomised controlled trial and economic evaluation of a task-based weight management group programme. BMC Public Health. 2019;19:1–10. doi: 10.1186/s12889-019-6679-3.
    1. van Keulen HM, Bosmans JE, van Tulder MW, Severens JL, de Vries H, Brug J, et al. Cost-effectiveness of tailored print communication, telephone motivational interviewing, and a combination of the two: results of an economic evaluation alongside the Vitalum randomized controlled trial. Int J Behav Nutr Phys Act. 2010;7:1–12. doi: 10.1186/1479-5868-7-1.
    1. Lee JT, Lawson KD, Wan Y, Majeed A, Morris S, Soljak M, Millett C. Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence. Prev Med (Baltim) 2017;99:49–57. doi: 10.1016/j.ypmed.2017.01.005.
    1. GC V, Wilson ECF, Suhrcke M, Hardeman W, Sutton S. Are brief interventions to increase physical activity cost-effective? A systematic review. Br J Sports Med. 2016;50:408–417. doi: 10.1136/bjsports-2015-094655.
    1. Zabaleta-Del-Olmo E, Pombo H, Pons-Vigues M, Casajuana-Closas M, Pujol-Ribera E, Lopez-Jimenez T, et al. Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial. BMC Public Health. 2018;18(1):874. doi: 10.1186/s12889-018-5805-y.
    1. Bernal E, Sandra D, Juan G-A, Fernando O, Sánchez Martínez I, Ramón J, et al. Spain: health system review. Health Systems in Transition. 2018;20:1–179.
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655.
    1. Bully P, Sánchez Á, Zabaleta-del-Olmo E, Pombo H, Grandes G. Evidence from interventions based on theoretical models for lifestyle modification (physical activity, diet, alcohol and tobacco use) in primary care settings: a systematic review. Prev Med (Baltim). 2015;76(S):S76–S93. doi: 10.1016/j.ypmed.2014.12.020.
    1. March S, Torres E, Ramos M, Ripoll J, García A, Bulilete O, Medina D, Vidal C, Cabeza E, Llull M, Zabaleta-del-Olmo E, Aranda JM, Sastre S, Llobera J. Adult community health-promoting interventions in primary health care: a systematic review. Prev Med (Baltim). 2015;76(S):S94–104. doi: 10.1016/j.ypmed.2015.01.016.
    1. Sanchez A, Bully P, Martinez C, Grandes G. Effectiveness of physical activity promotion interventions in primary care: a review of reviews. Prev Med (Baltim). 2015;76(S):S56–S67. doi: 10.1016/j.ypmed.2014.09.012.
    1. Maderuelo-Fernandez JA, Recio-Rodríguez JI, Patino-Alonso MC, Pérez-Arechaederra D, Rodriguez-Sanchez E, Gomez-Marcos MA, García-Ortiz L. Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: a systematic review. Prev Med (Baltim). 2015;76(S):S39–S55. doi: 10.1016/j.ypmed.2014.12.011.
    1. Cantera CM, Puigdomènech E, Ballvé JL, Arias OL, Clemente L, Casas R, et al. Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review. BMJ Open. BMJ Open. 2015;5(10):e008807.
    1. Zabaleta-del-Olmo E, Bolibar B, Garcia-Ortiz L, Garcia-Campayo J, Llobera J, Bellon JA, et al. Building interventions in primary health care for long-term effectiveness in health promotion and disease prevention. A focus on complex and multi-risk interventions. Prev Med. 2015;76(Suppl):S1–S4. doi: 10.1016/j.ypmed.2015.03.011.
    1. Moreno-Peral P, Conejo-Ceron S, Fernandez A, Berenguera A, Martinez-Andres M, Pons-Vigues M, et al. Primary care patients’ perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis. PLoS One. 2015;10(5):e0125004. doi: 10.1371/journal.pone.0125004.
    1. Rubio-Valera M, Pons-Vigues M, Martinez-Andres M, Moreno-Peral P, Berenguera A, Fernandez A. Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography. PLoS One. 2014;9(2):e89554. doi: 10.1371/journal.pone.0089554.
    1. Gómez-Gómez I, Bellón J, Resurrección DM, Cuijpers P, Moreno-Peral P, Rigabert A, et al. Effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms: systematic review and meta-analysis. Prev Med (Baltim) 2020;134(March):106067. doi: 10.1016/j.ypmed.2020.106067.
    1. Gil-Girbau M, Pons-Vigués M, Rubio-Valera M, Murrugarra G, Masluk B, Rodríguez-Martín B, García Pineda A, Vidal Thomás C, Conejo-Cerón S, Recio JI, Martínez C, Pujol-Ribera E, Berenguera A. Modelos Teóricos De Promoción De La Salud En La Práctica Habitual En Atención Primaria De Salud. Gac Sanit. 2021;35(1):48–59. doi: 10.1016/j.gaceta.2019.06.011.
    1. Pons-Vigués M, Berenguera A, Coma-Auli N, Pombo-Ramos H, March S, Asensio-Martínez A, et al. Health-care users, key community informants and primary health care workers’ views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions. Int J Equity Health. 2017;16:1–16. doi: 10.1186/s12939-017-0590-2.
    1. Berenguera A, Pons-Vigues M, Moreno-Peral P, March S, Ripoll J, Rubio-Valera M, et al. Beyond the consultation room: proposals to approach health promotion in primary care according to health-care users, key community informants and primary care Centre workers. Heal Expect an Int J public Particip Heal Care Heal Policy. 2017;20:896–910.
    1. Prochaska JO, Velicer WF. The Transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48. doi: 10.4278/0890-1171-12.1.38.
    1. Brotons-Cuixart C, Alemán-Sánchez JJ, Banegas-Banegas JR, Fondón-León C, Lobos-Bejarano JM, Martín-Rioboó E, et al. Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2018. Aten Primaria. 2018;50(Supl 1):4–28. doi: 10.1016/S0212-6567(18)30360-3.
    1. Buitrago Ramírez F, Ciurana Misol R, Chocrón Bentata L, Del CFAM, García Campayo J, Montón Franco C, et al. Prevención de los trastornos de la salud mental en atención primaria. Actualización PAPPS 2018. Aten Primaria. 2018;50(Supl 1):83–108. doi: 10.1016/S0212-6567(18)30364-0.
    1. Córdoba-García R, Camarelles-Guillem F, Muñoz-Seco E, Gómez-Puente JM, San-José-Arango J, Ramírez-Manent JI, et al. Recomendaciones sobre el estilo de vida. Actualizacón PAPPS 2018. Aten Primaria. 2018;50(Supl 1):29–40. doi: 10.1016/S0212-6567(18)30361-5.
    1. Marzo-Castillejo M, Vela-Vallespín C, Bellas-Beceiro B, Bartolomé-Moreno C, Melús-Palazón E, Vilarrubí-Estrella M, et al. Recomendaciones de prevención del cáncer. Actualización PAPPS 2018. Aten Primaria. 2018;50(Supl 1):41–65. doi: 10.1016/S0212-6567(18)30362-7.
    1. Aldaz-Herce P, Morató-Agustí ML, Gómez-Marco JJ, Javierre-Miranda AP, Martín-Martín S, Moreno-Millán N, et al. Prevención de las enfermedades infecciosas. Actualización PAPPS en vacunas 2018. Aten Primaria. 2018;50(Supl 1):66–82. doi: 10.1016/S0212-6567(18)30363-9.
    1. Badia X, Schiaffino A, Alonso J, Herdman M. Using the EuroQoI 5-D in the Catalan general population: feasibility and construct validity. Qual Life Res. 1998;7(4):311–322. doi: 10.1023/A:1008894502042.
    1. The EuroQol Group EuroQol - a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208. doi: 10.1016/0168-8510(90)90421-9.
    1. Marrugat J, Subirana I, Comín E, Cabezas C, Vila J, Elosua R, et al. Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA study. J Epidemiol Community Health. 2007;61(1):40–47. doi: 10.1136/jech.2005.038505.
    1. Ramos R, Solanas P, Cordón F, Rohlfs I, Elosua R, Sala J, et al. Comparación de la función de Framingham original y la calibrada del REGICOR en la predicción del riesgo coronario poblacional. Med Clin (Barc) 2003;121:521–526. doi: 10.1016/S0025-7753(03)74007-X.
    1. Marrugat J, Solanas P, D’Agostino R, Sullivan L, Ordovas J, Cordón F, Ramos R, Sala J, Masià R, Rohlfs I, Elosua R, Kannel WB. Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada. Rev Esp Cardiol. 2003;56(3):253–261. doi: 10.1016/S0300-8932(03)76861-4.
    1. Franklin M, Lomas J, Walker S, Young T. An educational review about using cost data for the purpose of cost-effectiveness analysis. Pharmacoeconomics. 2019;37(5):631–643. doi: 10.1007/s40273-019-00771-y.
    1. Zabaleta-Del-Olmo E, Casajuana-Closas M, López-Jiménez T, Pombo H, Pons-Vigués M, Pujol-Ribera E, et al. Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectivenessimplementation cluster randomised trial. 2020. PREPRINT (Version 1) available at Research Square [10.21203/-52192/v1].
    1. Broekhuizen K, Simmons D, Devlieger R, van Assche A, Jans G, Galjaard S, et al. Cost-effectiveness of healthy eating and/or physical activity promotion in pregnant women at increased risk of gestational diabetes mellitus: economic evaluation alongside the DALI study, a European multicenter randomized controlled trial. Int J Behav Nutr Phys Act. 2018;15:1–12. doi: 10.1186/s12966-018-0643-y.
    1. Fernández A, Mendive JM, Conejo-Cerón S, Moreno-Peral P, King M, Nazareth I, Martín-Pérez C, Fernández-Alonso C, Rodríguez-Bayón A, Aiarzaguena JM, Montón-Franco C, Serrano-Blanco A, Ibañez-Casas I, Rodríguez-Sánchez E, Salvador-Carulla L, Garay PB, Ballesta-Rodríguez MI, LaFuente P, del Mar Muñoz-García M, Mínguez-Gonzalo P, Araujo L, Palao D, Gómez MC, Zubiaga F, Navas-Campaña D, Aranda-Regules JM, Rodriguez-Morejón A, de Dios Luna J, Bellón JÁ. A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial. BMC Med. 2018;16(1):28. doi: 10.1186/s12916-018-1005-y.
    1. Osborn D, Burton A, Hunter R, Marston L, Atkins L, Barnes T, Blackburn R, Craig T, Gilbert H, Heinkel S, Holt R, King M, Michie S, Morris R, Morris S, Nazareth I, Omar R, Petersen I, Peveler R, Pinfold V, Walters K. Clinical and cost-effectiveness of an intervention for reducing cholesterol and cardiovascular risk for people with severe mental illness in English primary care: a cluster randomised controlled trial. Lancet Psychiatry. 2018;5(2):145–154. doi: 10.1016/S2215-0366(18)30007-5.
    1. Tsiachristas A, Burgers L, Rutten-Van Mölken MPMH. Cost-effectiveness of disease management programs for cardiovascular risk and COPD in the Netherlands. Value Heal. 2015;18(8):977–986. doi: 10.1016/j.jval.2015.07.007.
    1. Vallejo-Torres L, García-Lorenzo B, Serrano-Aguilar P. Estimating a cost-effectiveness threshold for the Spanish NHS. Heal Econ (United Kingdom). 2018;27:746–61.
    1. Tate DF, Finkelstein EA, Khavjou O, Gustafson A. Cost effectiveness of internet interventions: review and recommendations. Ann Behav Med. 2009;38(1):40–45. doi: 10.1007/s12160-009-9131-6.
    1. Hyewon HL, Levine M. Determing the threshold of acceptability of an ICER when natural health units are used. J Popul Ther Clin Pharmacol. 2012;19(2):e234–e238.
    1. World Health Organization. Prevention of cardiovascular disease: Guidelines for assessment and management of cardiovascular risk. Geneva: World Health Organization; 2007.
    1. Näslund U, Ng N, Lundgren A, Fhärm E, Grönlund C, Johansson H, Lindahl B, Lindahl B, Lindvall K, Nilsson SK, Nordin M, Nordin S, Nyman E, Rocklöv J, Vanoli D, Weinehall L, Wennberg P, Wester P, Norberg M. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet. 2019;393(10167):133–142. doi: 10.1016/S0140-6736(18)32818-6.
    1. Byford S, Sefton T. Economic evaluation of complex health and social care interventions. Natl Inst Econ Rev. 2003;186:98–108. doi: 10.1177/002795010300100114.

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