4. Discussion
REGRESSION, HYPERCHOLESTEROLEMIA, CHRONIC DISEASES
This health economic evaluation shows that the community-based lifestyle intervention was able to reduce total costs over the 24-month course of this study compared to baseline. Compared to the CG, total costs were significantly reduced at tThe significant reduction in total costs after 18 months within the CG (−22.43 ± 46.82 EUR; Regarding the HLCP-2, the cost reduction was primarily attributed to direct costs (including costs of medications, physician visits, treatments, therapeutic appliances and remedies). Direct costs were significantly improved in the IG intra-group comparison at all time points and in the CG inter-group comparison at all time points, except for the last two time points in the baseline comparison. Our results could be attributed to an improvement in clinical parameters, such as body weight, BMI, waist circumference, resting heart rate, blood lipids and fasting glucose, which changed significantly more in the IG than in the CG after one year compared to baseline due to a change in lifestyle [The indirect costs could only be improved to a small extent by the 2-year HLCP-2 intervention (tThese outliers were largely related to parameters that cannot be influenced by lifestyle changes in the short term. For example, early retirement is associated with chronic diseases, unhealthy lifestyles behavior and poor health [A German randomized controlled trial by Müller-Nordhorn et al. (2008) that used the same health economic questionnaires found that indirect costs (56%) were proportionately higher than direct costs (44%), with disease-related early retirement responsible for the highest costs (42%) in patients with hypercholesterolemia, which differs from our study results [Although there are no directly comparable studies, there are several studies that address the relationships between lifestyle factors and health economic issues related to NCDs and emphasize the cost-saving potential of these interventions [A strength of the present study is the use of a non-intervention control group, the assessment of a large variety of parameters and the complex real-world setting. All health economic parameters were collected at all six measurement points, which permits an evaluation of the costs over a period of 2 years. By means of the specific collection of health economic parameters, individual and specific cost allocation from a societal perspective was possible. The main limitation of this study is that the CG started with a delay of 6 months (same follow-up duration) compared to the IG (IG: April 2018; CG: October 2018). While both groups were comparable at baseline, except for age and education level, and we adjusted for potential confounders in the multiple linear regression analysis, some bias, such as selection bias, may have remained. Additionally, the sample size was rather small, and some time points (IG: t