Lifestyle Changes Boost Quality of Life for CHD Patients

Margareta Eriksson, PhD, of Björknås Health Care Center in Boden, Sweden, and colleagues reported that the randomized intervention study, conducted among more than 150 men and women and involving supervised exercise and dietary counseling, was also found to be highly cost-effective.

The main results of the study -- reported last year -- showed that the intervention improved several risk factors during the study, including physical activity levels, fitness, waist circumference, waist-to-hip ratio, blood pressure, and smoking.

Eriksson and her colleagues wrote, "Such programs may be a wise use of resources in primary healthcare for patients with diseases to which inactivity strongly contributes."

The Björknås study included 151 men and women ages 18 to 65 (mean age 54.4) recruited from a primary care center in northern Sweden. All participants had at least one of the following conditions: hypertension, dyslipidemia, Type 2 diabetes, or obesity. They all were largely sedentary at baseline.

The researchers randomized the participants to a lifestyle intervention plus usual care or usual care alone. The intervention consisted of supervised exercise sessions three times a week and diet counseling on five separate occasions for the first three months of the study, followed by regular meetings over three years.

Quality of life was assessed using three separate measures -- the EuroQol 5D and visual analog scale (VAS), the 36-item Short Form Health Survey, and the Short Form 6D.

Over the three-year study period, there were significantly greater improvements in quality of life with the intervention on the EuroQol VAS, Short Form 6D, and physical component summary of the Short Form-36 (P<0.05 for all). However, the effect sizes were small to moderate. There were no significant differences between the two groups on the EuroQol 5D or the mental component summary of the Short Form-36.

Costs, including expenses related to the intervention and the costs of increased physical activity, were $337 higher in the intervention group. Those were offset, however, by savings of $384 due to fewer healthcare visits among the intervention group. The net savings with the intervention was $47 per participant.

Using the various measures of quality of life, the costs per quality-adjusted life year gained were $1,668 to $4,813 in the intervention group.

Assuming society's willingness to pay $50,000 per quality-adjusted life year gained, the probability that the intervention would be cost-effective ranged from 89% to 100%, depending on the different measures of quality of life.

The authors noted that the study was not powered to detect differences in quality of life, and thus may have been too small to detect significant but smaller improvements in other quality of life variables. The Björknäs study was also performed in one primary care setting, "typical of Northern and Western European healthcare systems, with limited resources," the researchers noted. This may limit its generalizations to other care settings in other countries and populations.

But they added that their program and the U.S. Diabetes Prevention program both produced similar improvements in quality of life.

• Explain to interested patients that a Swedish study found a three-year lifestyle intervention significantly improved quality of life compared with standard care in patients with hypertension, Type 2 diabetes, dyslipidemia, and/or obesity.
  
  
• Note that the study also found the intervention program was cost-effective.

Eriksson M, et al "Quality of life and cost-effectiveness of a three-year trial of lifestyle intervention in primary healthcare" Arch Intern Med 2010; 170: 1470-1479.