Cost-effectiveness of WISEWOMAN, a program aimed at reducing heart disease risk among low-income women

Objective: To quantify the cost-effectiveness of the WISEWOMAN program. WISEWOMAN is a Centers for Disease Control and Prevention (CDC)-funded lifestyle intervention program that provides low-income uninsured women aged 40 - 64 with chronic disease risk factor screenings, lifestyle interventions, and referral services in an effort to prevent coronary heart disease (CHD) and improve health. Methods: We used data for 3015 WISEWOMAN participants who completed baseline and 1-year follow-up screenings. We quantified the average per capita cost of providing WISEWOMAN over the last 6 months of the reporting period. We assessed 1-year reductions in select CHD risk factors. We calculated the cost-effectiveness ratio by dividing the average per capita cost by average predicted life-years gained. Results: The cost of providing WISEWOMAN services to each additional participant averaged $270 per participant. Participants significantly improved their systolic (1.3%) and diastolic (1.7%) blood pressure, total (2%) and high-density lipoprotein (HDL) (0.7%) cholesterol, and 10-year risk of CHD (8.7%). There were also significant reductions in percent of women who smoked (11.7%) or had high blood pressure (15.8%) or high cholesterol (13.1%). The best-case cost-effectiveness ratio was $470 per percentage point reduction in CHD risk, or $4400 per discounted life-year gained; however, sensitivity analysis revealed substantial uncertainty around this estimate. Conclusions: Although more research is needed to confirm the assumptions used in the model, results of our analysis suggest that the WISEWOMAN program is a cost-effective approach for reducing CVD risk among low-income, uninsured women aged 40 - 64, especially if improvements in risk factors are sustainable when program participation concludes.