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

BackgroundThe aim of the present study was to evaluate the cost-effectiveness of tailored print communication (TPC), telephone motivational interviewing (TMI), a combination of the two, and no intervention on two outcomes in adults aged 45 to 70, half of them having hypertension: increasing the number of public health guidelines met for three behaviors (physical activity and fruit and vegetable consumption), and impact on quality adjusted life years (QALYs).MethodsParticipants (n = 1,629) from 23 Dutch general practices were randomized into one of four groups, which received 4 TPCs, 4 TMIs, 2 of each (combined), or no intervention (control), respectively. The self-reported outcomes, measured at baseline and 73 weeks follow-up (7 months after the last intervention component), were difference in total number of guidelines met at follow-up compared to baseline, and number of QALYs experienced over 73 weeks. The costs of implementing the intervention were estimated using a bottom-up approach.ResultsAt 73 weeks follow-up participants showed increased adherence with 0.62 (TPC), 0.40 (TMI), 0.50 (combined), and 0.26 (control) guidelines compared to baseline, and experienced 1.09, 1.08, 1.08, and 1.07 QALYs, respectively. The costs for the control group were considered to be zero. TMI was more expensive (€107 per person) than both the combined intervention (€80) and TPC (€57). The control condition was most cost-effective for lower ceiling ratios, while TPC had the highest probability of being most cost-effective for higher ceiling ratios (more than €160 per additional guideline met, and €2,851 for each individual QALY).ConclusionsFor low society's willingness to pay, the control group was most cost-effective for the number of QALYs experienced over 73 weeks. This also applied to the increase in the number of guidelines met at lower ceiling ratios, whereas at higher ceiling ratios, TPC had a higher probability of being more cost-effective than the TMI, combined or control conditions. This also seemed to apply for QALYs experienced over 73 weeks. More research is needed on the long-term efficacy of both TPC and TMI, as well as on how to increase their cost-effectiveness.Trial registrationDutch Trial Register NTR1068

[1]  A. Bauman,et al.  Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. , 2007, Circulation.

[2]  D. McNeil,et al.  Review of Motivational Interviewing in promoting health behaviors. , 2009, Clinical psychology review.

[3]  W. Saris,et al.  Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. , 2003, Journal of clinical epidemiology.

[4]  R. Collins,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002, The Lancet.

[5]  S. Wilson.  Methods for the economic evaluation of health care programmes , 1987 .

[6]  T. Byers,et al.  The association between leisure-time physical activity and dietary fat in American adults. , 1995, American journal of public health.

[7]  L. Segal,et al.  Time to give nutrition interventions a higher profile: cost-effectiveness of 10 nutrition interventions. , 2007, Health promotion international.

[8]  Bengt Jönsson,et al.  Ten arguments for a societal perspective in the economic evaluation of medical innovations , 2009, The European Journal of Health Economics.

[9]  P Whelton,et al.  Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. , 1995, Hypertension.

[10]  J. Prochaska,et al.  Initial efficacy of MI, TTM tailoring and HRI's with multiple behaviors for employee health promotion. , 2008, Preventive medicine.

[11]  Boyd Swinburn,et al.  Diet, nutrition and the prevention of chronic diseases. , 2003, World Health Organization technical report series.

[12]  Mohsen Mesgarani,et al.  Book Review: Diet, Nutrition and the Prevention of Chronic Diseases , 2003, World Health Organization technical report series.

[13]  Stephen Rollnick,et al.  Ten things that motivational interviewing is not. , 2009, Behavioural and cognitive psychotherapy.

[14]  L. Neville,et al.  Computer-tailored dietary behaviour change interventions: a systematic review , 2009, Health education research.

[15]  K. Emmons,et al.  How can we increase translation of research into practice? Types of evidence needed. , 2007, Annual review of public health.

[16]  A. Manley.  Physical Activity And Health: A Report Of The Surgeon General , 2004 .

[17]  P. Whelton,et al.  Trends in the prevalence, awareness, treatment, and control of cardiovascular disease risk factors among noninstitutionalized patients with a history of myocardial infarction and stroke. , 2006, American journal of epidemiology.

[18]  H. Grundmeijer,et al.  NHG-Standaard Hypertensie , 2003 .

[19]  B. Rimer,et al.  Advancing Tailored Health Communication: A Persuasion and Message Effects Perspective , 2006 .

[20]  J. Graf von der Schulenburg,et al.  Review of European guidelines for economic evaluation of medical technologies and pharmaceuticals , 2000, HEPAC Health Economics in Prevention and Care.

[21]  J. Sallis,et al.  Interrelationships between physical activity and other health behaviors among university women and men. , 1998, Preventive medicine.

[22]  Guilbert Jj.  The world health report 2002 - reducing risks, promoting healthy life. , 2003 .

[23]  Brian L. Burke,et al.  The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. , 2003, Journal of consulting and clinical psychology.

[24]  M J Al,et al.  Costs, effects and C/E-ratios alongside a clinical trial. , 1994, Health economics.

[25]  S. Kremers,et al.  Clustering of diet, physical activity and smoking and a general willingness to change , 2008, Psychology & health.

[26]  Age , 2000, BMJ : British Medical Journal.

[27]  J. Schafer,et al.  Missing data: our view of the state of the art. , 2002, Psychological methods.

[28]  A H Briggs,et al.  Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. , 1997, Health economics.

[29]  D. Edington.  Emerging Research: A View from One Research Center , 2001, American journal of health promotion : AJHP.

[30]  Marjan van den Akker,et al.  Clusters of lifestyle behaviors: results from the Dutch SMILE study. , 2008, Preventive medicine.

[31]  L. Hunt,et al.  Missing Data in Clinical Studies , 2007 .

[32]  M. Campbell,et al.  Tailored Interventions in Public Health , 2006 .

[33]  D. Edington,et al.  The financial impact of changes in personal health practices. , 1997, Journal of occupational and environmental medicine.

[34]  N. Schwarz.  Self-reports: How the questions shape the answers. , 1999 .

[35]  S. Noar,et al.  Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. , 2007, Psychological bulletin.

[36]  Alastair Gray,et al.  Economic burden of cardiovascular diseases in the enlarged European Union. , 2006, European heart journal.

[37]  Peter E. Hilsenrath,et al.  The World Health Report 2000 , 2002 .

[38]  J. Brazier,et al.  The estimation of a preference-based measure of health from the SF-36. , 2002, Journal of health economics.

[39]  Ross C Brownson,et al.  Methodologic challenges in disseminating evidence-based interventions to promote physical activity. , 2006, American journal of preventive medicine.

[40]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[41]  D. Goldspink,et al.  Ageing and activity: their effects on the functional reserve capacities of the heart and vascular smooth and skeletal muscles , 2005, Ergonomics.

[42]  M. Weinstein,et al.  QALYs: the basics. , 2009, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[43]  Gwen L. Alexander,et al.  Cost analyses of a web-based behavioral intervention to enhance fruit and vegetable consumption , 2009, The international journal of behavioral nutrition and physical activity.

[44]  Prevention of Cardiovascular Disease Guidelines for assessment and management of cardiovascular risk , 2007 .

[45]  Gregory J. Welk,et al.  Physical Activity Assessments for Health-Related Research , 2002 .

[46]  W. Mechelen,et al.  Vitalum study design: RCT evaluating the efficacy of tailored print communication and telephone motivational interviewing on multiple health behaviors , 2008, BMC public health.

[47]  B. Devellis,et al.  A Randomized Trial of Tailoring and Motivational Interviewing to Promote Fruit and Vegetable Consumption for Cancer Prevention and Control , 2009, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[48]  W. Patterson.  ICPC: International classification of primary care , 1988 .

[49]  P. Williams,et al.  Physical activity and public health. , 1995, JAMA.

[50]  B. Bentsen.  International classification of primary care. , 1986, Scandinavian journal of primary health care.

[51]  F P Rivara,et al.  The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. , 2001, Addiction.

[52]  H. V. Keulen.  Vitalum : development and evaluation of tailored print communication and telephone motivational interviewing to improve lifestyle behaviors among older adults , 2010 .

[53]  M. Kreuter,et al.  Tailoring: what's in a name? , 2000, Health education research.

[54]  Sc Prospective,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002 .

[55]  A. W. Musschenga.  Zinnige en duurzame zorg , 2007 .

[56]  P. van Assema,et al.  Reproducibility, validity, and responsiveness to change of a short questionnaire for measuring fruit and vegetable intake. , 2004, American journal of epidemiology.

[57]  J. Viikari,et al.  Clustering of risk habits in young adults. The Cardiovascular Risk in Young Finns Study. , 1995, American journal of epidemiology.

[58]  M. Sevick,et al.  Cost-effectiveness of alternative approaches for motivating activity in sedentary adults: results of Project STRIDE. , 2007, Preventive medicine.

[59]  A. Gibson,et al.  Motivational interviewing. , 2000, The practising midwife.

[60]  Richard E. Lucas,et al.  CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE Adaptation and the Set-Point Model of Subjective Well-Being Does Happiness Change After Major Life Events? , 2022 .

[61]  J. E. Brazier,et al.  Validating the SF-36 health survey questionnaire: new outcome measure for primary care. , 1992, BMJ.

[62]  A. Schuit,et al.  Clustering of lifestyle risk factors in a general adult population. , 2002, Preventive medicine.

[63]  Richard E. Lucas,et al.  Beyond the hedonic treadmill: revising the adaptation theory of well-being. , 2006, The American psychologist.

[64]  B E Ainsworth,et al.  Compendium of physical activities: an update of activity codes and MET intensities. , 2000, Medicine and science in sports and exercise.

[65]  Terry Wang,et al.  Validity of a modified CHAMPS physical activity questionnaire among African-Americans. , 2003, Medicine and science in sports and exercise.

[66]  J. Knottnerus,et al.  Computerized health information in The Netherlands: a registration network of family practices. , 1992, The British journal of general practice : the journal of the Royal College of General Practitioners.