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

Nana Anokye, Julia Fox-Rushby, Sabina Sanghera, Derek Cook, Cheryl Furness, Sally Kerry, Christina Victor, Steve Iliffe, Michael H Ussher, Peter Whincup, Ulf Ekelund, Stephen DeWilde, Tess Harris

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
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Abstract

Objectives: A short- 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, United Kingdom

Participants: a) Short-term CEA: 1023 people (922 households) aged 45-75yrs without physical activity (PA) contraindications b) Long-term CEA: 100,000 cohort aged 59-88yrs

Interventions: Pedometers, 12-wk 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-12 months) in average daily step-count and time in 10-min bouts of moderate-vigorous PA, and EQ5D5L quality adjusted life-years (QALYs)

Methods: Resource use costs (£2013/4) from an NHS perspective, presented as incremental cost effectiveness ratios for each outcome over a 1-year and life-time 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) per minute in ≥10 minute 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 (+759QALYs, 95% CI 400, 1247) and lower costs (-£11m, 95% CI -12, -10), than control and nurse groups, resulting in an incremental net monetary benefit of £26m 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 one year. Further research should ascertain maintenance of the higher levels of PA, and its impact on quality of life and health service use.
Original languageEnglish
Article numbere021978
Number of pages10
JournalBMJ Open
Volume8
Issue number10
Early online date17 Oct 2018
DOIs
Publication statusPublished - 17 Oct 2018

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