Cost-effectiveness of selective cardiometabolic disease prevention in primary care

Cost-effective preventive strategies are needed to anticipate the rising burden of cardiometabolic diseases (CMD), including cardiovascular disease, diabetes type 2 and chronic kidney disease. The guideline ‘the prevention consultation’ was developed by the Dutch College of General Practitioners to provide a framework for selective stepwise CMD prevention in primary care. The INTEGRATE study compared the stepwise CMD risk assessment followed by individualized treatment with care as usual in 37 Dutch general practices. In this thesis, we evaluated the (cost)-effectiveness of this program. We found that implementation of this program is feasible and effective, and can detect high-risk individuals in a simple and non-invasive way. The program resulted in significant improvements in cholesterol and blood pressure levels after one year. The participating practices were adequately organized to facilitate a CMD prevention program. We found no evidence that practice-related factors were associated to its effect. Risk perception among the study participants was generally low, even among high-risk participants, and no differences were found in risk perception between the intervention and control group. We concluded that risk communication through an online risk score did not lead to more adequate risk perception. Although the program was successful in detecting CMD and resulted in significant improvements in cholesterol and blood pressure levels, it was not cost-effective in short and long term outcomes. Therefore, we do not recommend large-scale implementation. CMD prevention should be a focus of public health and environmental initiatives and not a priority of curative health care.