Research articleCost Effectiveness of Community-Based Physical Activity Interventions
Introduction
Physical inactivity is a global public health problem, and has been identified as a national public health priority.1, 2, 3 There is clear evidence to link physical inactivity with an increased risk of many chronic diseases, including coronary heart disease (CHD), ischemic stroke, type 2 diabetes, breast cancer, and colorectal cancer.1, 2, 3 The negative health effects of physical inactivity are paralleled by staggering economic consequences: the annual cost directly attributable to inactivity in the U.S. is an estimated $24 billion–$76 billion, or 2.4%–5.0% of national healthcare expenditures.4, 5, 6
Fortunately, modest increases in physical activity have the potential to produce substantial health benefits.7 Further, systematic reviews of population-based interventions to promote health and prevent disease have provided strong evidence that public health efforts can successfully increase physical activity.8, 9 It appears that sustained physical activity initiatives could make substantial contributions to the control of chronic diseases. However, the potential benefits of physical activity promotion have not yet been fully realized, and the majority of adults in the U.S. (54.1%) do not engage in sufficient physical activity to meet public health recommendations.10 This situation presents an important opportunity to evaluate the merits of competing physical activity promotion strategies and to develop effective public health policy. The need for decision making in an environment of uncertainty, scarcity, and competing priorities makes the use of cost-effectiveness analysis (CEA) attractive for public health planning.
These analyses attempt to answer the question How much health improvement can be gained when an intervention is compared, dollar for dollar, with an alternative? Rather than promoting cost savings, the goal of CEA is to determine how money can be spent with maximum public health benefit. Decision-analytic models have been used routinely to guide important public health policy decisions, from airbag regulation in motor vehicles and the widespread use of pneumococcal vaccine in older adults11, 12 to the improvement of cervical cancer screening practices globally.13 Models have also been used to influence clinical practice guidelines for cardiovascular disease prevention14, 15 and to promote national anti-tobacco education efforts.16 Markov models, which consider probabilistic events over time, are particularly well-suited to evaluate population-based health promotion efforts and to examine outcomes over an extended period of time.
The purpose of this study was to evaluate the cost-effectiveness (dollars per quality-adjusted life year [QALY] gained) of seven exemplar interventions to increase physical activity, relative to no intervention, as well as to follow disease incidence over a lifetime. This study is the first to integrate the best available epidemiologic and intervention data on physical activity into a CEA of the most promising public health interventions for physical activity promotion.
Section snippets
The CDC Measurement of the Value of Exercise (MOVE) Model
A comprehensive, flexible, state-transition Markov model was developed from a societal perspective to estimate the lifetime costs, health gains, and cost-effectiveness of population interventions that promote physical activity among U.S. adults. Cost-effectiveness is defined as the ratio of incremental costs (dollars) to incremental QALYs. The incremental cost is the difference between the total expected cost of the intervention and the total expected cost of no intervention. Incremental QALYs
Average Cost Effectiveness
Estimates of the population health and economic outcomes associated with each intervention are shown in Table 4. Summarized are the average costs, effectiveness, and cost-effectiveness ratios associated with a one-time application of each physical activity promotion intervention relative to no intervention. Results are cumulative over a 40-year time-horizon for the whole U.S. population, aged 25–64 years, but average per-person values are reported here. Absent any new intervention to improve
Conclusion
All of the evaluated physical activity interventions were found to be cost-effective and offered good value for money, with gains in both survival and health-related QOL, and with reasonable cost-per-QALY and cost-per-life-year ratios. These results support using any of the seven evaluated interventions as part of public health efforts to promote physical activity. Factors specific to implementing interventions within a given strategy and setting may introduce greater variability in
References (68)
- et al.
The effectiveness of interventions to increase physical activity: a systematic review
Am J Prev Med
(2002) - et al.
Developing the Guide to Community Preventive Services—overview and rationaleThe Task Force on Community Preventive Services
Am J Prev Med
(2000) - et al.
The cost-effectiveness of intensive national school-based anti-tobacco education: results from the tobacco policy model
Prev Med
(2001) - et al.
Physical fitness gains following simple environmental change
Am J Prev Med
(1991) - et al.
Wheeling Walks: a community campaign using paid media to encourage walking among sedentary older adults
Prev Med
(2002) - et al.
The cost-effectiveness of a cardiovascular risk reduction program in general practice
Health Policy
(1997) - et al.
Cost-utility analyses of clinical preventive services: published ratios, 1976–1997
Am J Prev Med
(2000) Key concepts in model selection: performance and generalizability
J Math Psychol
(2000)A global strategy for diet, physical activity, and health
(2004)Preventing chronic diseases: a vital investment
(2005)
Physical activity and health: a report of the Surgeon General
Economic costs of obesity and inactivity
Med Sci Sports Exerc
Higher direct medical costs associated with physical inactivity
Phys Sportsmed
National and state-specific inactivity-attributable medical expenditures for six diseasesFinal report prepared for the Centers for Disease Control and Prevention by the Research Triangle Institute
Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association
Med Sci Sports Exerc
Adult participation in recommended levels of physical activity—U.S., 2001 and 2003
MMWR Morb Mortal Wkly Rep
The cost-effectiveness of air bags by seating position
JAMA
Pneumococcal vaccination in older adults
N Engl J Med
Cost-effectiveness of cervical-cancer screening in five developing countries
N Engl J Med
Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease
N Engl J Med
Cost-effectiveness of diagnostic strategies for patients with chest pain
Ann Intern Med
Dose-response issues concerning physical activity and health: an evidence-based symposium
Med Sci Sports Exerc
Behavioral Risk Factor Surveillance System: 2003 survey data
Projections of the resident population by age, sex, race, and Hispanic origin
Can we identify who will adhere to long-term physical activity?Signal detection methodology as a potential aid to clinical decision making
Health Psychol
Physical activity behavior change: issues in adoption and maintenance
Health Psychol
Prediction of coronary heart disease using risk factor categories
Circulation
Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register
J Neurol Neurosurg Psychiatry
Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989
Stroke
National diabetes fact sheet: U.S., 2003
National diabetes surveillance system: incidence of diabetes
Surveillance, epidemiology, and end results
The economic costs associated with physical inactivity and obesity in Canada: an update
Can J Appl Physiol
Physical activity and risk of stroke in women
JAMA
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