Summary: In a within-trial cost-effectiveness analysis of the PROLIFIC cluster RCT, a family-based structured lifestyle programme for relatives of patients with premature coronary heart disease improved quality-adjusted life years and cardiometabolic risk factors at an incremental cost of about Int$11,352 per QALY, well within accepted thresholds.
PICO Summary
| Element | Detail |
|---|---|
| Population | Adult first-degree relatives and spouses of patients with premature coronary heart disease; cluster RCT in Kerala, India. |
| Intervention | Family-based structured lifestyle programme delivered by non-physician health workers: risk screening, behaviour-change support, primary-care linkage, and active follow-up over 2 years. |
| Comparison | Usual care: one-time counselling plus annual screening. |
| Outcome | Incremental cost Int$157.5/person and QALY gain 0.014, giving an ICER of Int$11,352/QALY (cost-effective at 3x GDP per capita). Incremental cost per unit reduction was Int$28.5 (SBP), 26.9 (fasting glucose), 130.8 (HbA1c), 178.7 (total cholesterol), and 39.8 (waist circumference). |
Expert Commentary
This is a sensible and welcome economic analysis of a sound idea: the relatives of someone with premature coronary disease are a high-risk, under-served group, and the index event is a genuine teachable moment for a whole household that shares meals, habits, and environment. Treating the family as the unit, and using non-physician health workers rather than scarce physician time, is a pragmatic, scalable model, and an ICER around Int$11,352 per QALY is comfortably cost-effective by international standards. I read it positively, with the limitations stated plainly. The per-person QALY gain is small at 0.014, the analysis is within-trial over two years so it captures none of the compounding benefit a lifetime model would show, the endpoints are risk factors rather than actual cardiovascular events, and it was conducted in one Indian setting, so cost structures will not transfer directly. Can I use this with my patients? Yes, in the way it intends. It supports a practice I can adopt, when I see a patient with premature coronary disease, systematically engaging their first-degree relatives in screening and household-level lifestyle change rather than treating the patient in isolation. The economic case for scaling such programmes is solid; longer-horizon, event-based data would strengthen it further.
References
John AS, Ganapathi S, Harikrishnan S, et al. Within-trial cost-effectiveness analysis of a family-based structured lifestyle modification intervention program for cardiovascular risk reduction: results from the PROLIFIC trial. Glob Heart. 2025;20(1):65. doi:10.5334/gh.1450