Short-term and long-term cost-effectiveness of a pedometer-based exercise intervention in primary care: A within-trial analysis and beyond-trial modelling

Citation

Anokye N, Fox-Rushby J, Sanghera S, Cook DG, Limb E, Furness C, Kerry SM, Victor CR, Iliffe S, Ussher M, Whincup PH, Ekelund U, Dewilde S & Harris T (2018) Short-term and long-term cost-effectiveness of a pedometer-based exercise intervention in primary care: A within-trial analysis and beyond-trial modelling. BMJ Open, 8 (10), Art. No.: e021978. https://doi.org/10.1136/bmjopen-2018-021978

Abstract
Objectives A short-term and long-term cost-effectiveness analysis (CEA) of two pedometer-based walking interventions compared with usual care. Design (A) Short-term CEA: Parallel three-arm cluster randomised trial randomised by household. (B) Long-term CEA: Markov decision model. Setting Seven primary care practices in South London, UK. Participants (A) Short-term CEA: 1023 people (922 households) aged 45-75 years without physical activity (PA) contraindications. (b) Long-term CEA: A cohort of 100 000 people aged 59-88 years. Interventions Pedometers, 12-week walking programmes and PA diaries delivered by post or through three PA consultations with practice nurses. Primary and secondary outcome measures Accelerometer-measured change (baseline to 12 months) in average daily step count and time in 10 min bouts of moderate to vigorous PA (MVPA), and EQ-5D-5L quality-adjusted life-years (QALY). Methods Resource use costs (£2013/2014) from a National Health Service perspective, presented as incremental cost-effectiveness ratios for each outcome over a 1-year and lifetime horizon, with cost-effectiveness acceptability curves and willingness to pay per QALY. Deterministic and probabilistic sensitivity analyses evaluate uncertainty. Results (A) Short-term CEA: At 12 months, incremental cost was £3.61 (£109)/min in ≥10 min MVPA bouts for nurse support compared with control (postal group). At £20 000/QALY, the postal group had a 50% chance of being cost saving compared with control. (B) Long-term CEA: The postal group had more QALYs (+759 QALYs, 95% CI 400 to 1247) and lower costs (-£11 million, 95% CI -12 to -10) than control and nurse groups, resulting in an incremental net monetary benefit of £26 million per 100 000 population. Results were sensitive to reporting serious adverse events, excluding health service use, and including all participant costs. Conclusions Postal delivery of a pedometer intervention in primary care is cost-effective long term and has a 50% chance of being cost-effective, through resource savings, within 1 year. Further research should ascertain maintenance of the higher levels of PA, and its impact on quality of life and health service use. © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.

Keywords
accelerometry; adult; aged; Article; cohort analysis; consultation; controlled study; cost effectiveness analysis; EQ-5D-5L utility score; exercise; health care delivery; health care utilization; health economics; human; major clinical study; multicenter study; parallel design; pedometry; primary medical care; quality adjusted life year; quality of life assessment; randomized controlled trial; step count; walking; actimetry; activity tracker; age; clinical trial; cost benefit analysis; demography; economics; England; female; health promotion; male; Markov chain; mental health; middle aged; nurse; organization and management; postal mail; primary health care; program evaluation; self concept; sex factor; socioeconomics; very elderly, Actigraphy; Age Factors; Aged; Aged, 80 and over; Cost-Benefit Analysis; Female; Fitness Trackers; Health Promotion; Humans; London; Male; Markov Chains; Mental Health; Middle Aged; Nurses; Postal Service; Primary Health Care; Program Evaluation; Quality-Adjusted Life Years; Residence Characteristics; Self Efficacy; Sex Factors; Socioeconomic Factors; Walking

Journal
BMJ Open: Volume 8, Issue 10