| To Register SMDM Homepage | |
|
|
|
||||
Purpose: Our objective was to assess the cost-effectiveness of population-wide strategies to promote physical activity in adults.
Methods: We developed a novel and comprehensive state-transition Markov model to estimate the costs, health gains (QALYs), and cost-effectiveness of 4 alternate public health strategies to promote physical activity. To identify strategies, we selected those that were “strongly recommended” by the US Task Force for Preventive Services. Interventions exemplifying each of 4 strategies were evaluated. A community-wide campaign strategy was represented by a multi-factorial and multimedia-dependent health education intervention. An intervention emphasizing the use of personal trainers and financial incentives exemplified an individually-adapted health behavior change strategy. A social support strategy was represented by an intervention that incorporated organized walking groups, social gatherings, phone calls, and home visits. Finally, a strategy of enhanced access was characterized by an intervention that exposed an entire community to an environment conducive to an active lifestyle (e.g., new bicycle paths, fitness facility hour extension). Each intervention was compared to a no intervention alternative. Efficacy estimates were obtained from randomized controlled trials. A systematic review of disease burden by exercise status was used to assess the relative risk of 5 diseases (coronary heart disease, ischemic stroke, colorectal cancer, breast cancer, and type 2 diabetes) for each of the following physical activity levels: 1) inactive; 2) irregularly active, sufficiently active to minimally meet public health recommendations; and, 4) highly active. Quality of life data by disease state, exercise level, age, and gender were obtained using the Quality of Well Being Scale. Longitudinal medical costs for the disease states were gathered from a 400,000 member claims database and annualized using actuarial methods. Costs and QALYs were assessed from a societal perspective over 10, 20, 30, and 40 year time horizons and discounted back to the present at 3%.
Results: While the most effective strategy focused on enhancing access to physical activity, social support was the most cost-effective strategy at $6400 per QALY, assuming a 40-year time horizon. Enhanced access cost $34,000/QALY, individually adapted $73,000/QALY, and community campaign $110,000/QALY. Results were sensitive to intervention-related costs and efficacy.
Conclusion: For adults, social support offered the best value for money. However, compared with other well-accepted preventive strategies, all physical activity promotion strategies evaluated offered good value for money.
See more of Poster Session - CEA: Methods and Applications; Health Services Research
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)