Is brief advice in primary care a cost-effective way to promote physical activity?
Is brief advice in primary care a cost-effective way to promote physical activity?
Aim: this study models the cost-effectiveness of brief advice (BA) in primary care for physical activity (PA) addressing the limitations in the current limited economic literature through the use of a time-based modelling approach.
Methods: a Markov model was used to compare the lifetime costs and outcomes of a cohort of 100 000 people exposed to BA versus usual care. Health outcomes were expressed in terms of quality-adjusted life years (QALYs). Costs were assessed from a health provider perspective ( pound2010/11 prices). Data to populate the model were derived from systematic literature reviews and the literature searches of economic evaluations that were conducted for national guidelines. Deterministic and probability sensitivity analyses explored the uncertainty in parameter estimates including short-term mental health gains associated with PA.
Results: compared with usual care, BA is more expensive, incurring additional costs of pound806 809 but it is more effective leading to 466 QALYs gained in the total cohort, a QALY gain of 0.0047/person. The incremental cost per QALY of BA is pound1730 (including mental health gains) and thus can be considered cost-effective at a threshold of pound20 000/QALY. Most changes in assumptions resulted in the incremental cost-effectiveness ratio (ICER) falling at or below pound12 000/QALY gained. However, when short-term mental health gains were excluded the ICER was pound27 000/QALY gained. The probabilistic sensitivity analysis showed that, at a threshold of pound20 000/QALY, there was a 99.9% chance that BA would be cost-effective.
Conclusions: BA is a cost-effective way to improve PA among adults, provided short-term mental health gains are considered. Further research is required to provide more accurate evidence on factors contributing to the cost-effectiveness of BA.
adult, aged, cost-benefit analysis, counseling, exercise physiology, health promotion, markov chains, middle aged, primary health care/economics, quality-adjusted life years
202-216
Anokye, N.K.
3e35a9eb-a6c8-4c5d-9fee-c31fe3ed9c58
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Fox-Rushby, J.
ef1de2a2-a954-4aac-ac46-17302a58636a
2014
Anokye, N.K.
3e35a9eb-a6c8-4c5d-9fee-c31fe3ed9c58
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Fox-Rushby, J.
ef1de2a2-a954-4aac-ac46-17302a58636a
Anokye, N.K., Lord, J. and Fox-Rushby, J.
(2014)
Is brief advice in primary care a cost-effective way to promote physical activity?
British Journal of Sports Medicine, 48 (3), .
(doi:10.1136/bjsports-2013-092897).
(PMID:24352807)
Abstract
Aim: this study models the cost-effectiveness of brief advice (BA) in primary care for physical activity (PA) addressing the limitations in the current limited economic literature through the use of a time-based modelling approach.
Methods: a Markov model was used to compare the lifetime costs and outcomes of a cohort of 100 000 people exposed to BA versus usual care. Health outcomes were expressed in terms of quality-adjusted life years (QALYs). Costs were assessed from a health provider perspective ( pound2010/11 prices). Data to populate the model were derived from systematic literature reviews and the literature searches of economic evaluations that were conducted for national guidelines. Deterministic and probability sensitivity analyses explored the uncertainty in parameter estimates including short-term mental health gains associated with PA.
Results: compared with usual care, BA is more expensive, incurring additional costs of pound806 809 but it is more effective leading to 466 QALYs gained in the total cohort, a QALY gain of 0.0047/person. The incremental cost per QALY of BA is pound1730 (including mental health gains) and thus can be considered cost-effective at a threshold of pound20 000/QALY. Most changes in assumptions resulted in the incremental cost-effectiveness ratio (ICER) falling at or below pound12 000/QALY gained. However, when short-term mental health gains were excluded the ICER was pound27 000/QALY gained. The probabilistic sensitivity analysis showed that, at a threshold of pound20 000/QALY, there was a 99.9% chance that BA would be cost-effective.
Conclusions: BA is a cost-effective way to improve PA among adults, provided short-term mental health gains are considered. Further research is required to provide more accurate evidence on factors contributing to the cost-effectiveness of BA.
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Accepted/In Press date: 28 November 2013
e-pub ahead of print date: 18 December 2013
Published date: 2014
Keywords:
adult, aged, cost-benefit analysis, counseling, exercise physiology, health promotion, markov chains, middle aged, primary health care/economics, quality-adjusted life years
Organisations:
Primary Care & Population Sciences
Identifiers
Local EPrints ID: 382163
URI: http://eprints.soton.ac.uk/id/eprint/382163
ISSN: 0306-3674
PURE UUID: 96815a62-6556-4d59-9be5-531457776eeb
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Date deposited: 18 Jan 2016 10:05
Last modified: 15 Mar 2024 03:52
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Author:
N.K. Anokye
Author:
J. Fox-Rushby
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