Cost-effectiveness and cost-utility of a Web-based or print-delivered tailored intervention to promote physical activity among adults aged over fifty: an economic evaluation of the Active Plus interventionReportar como inadecuado

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International Journal of Behavioral Nutrition and Physical Activity

, 11:122

First Online: 28 September 2014Received: 25 March 2014Accepted: 19 September 2014


BackgroundThe adverse health effects of insufficient physical activity PA result in high costs to society. The economic burden of insufficient PA, which increases in our aging population, stresses the urgency for cost-effective interventions to promote PA among older adults. The current study provides insight in the cost-effectiveness and cost-utility of different versions of a tailored PA intervention Active Plus among adults aged over fifty.

MethodsThe intervention conditions i.e. print-delivered basic PB; N = 439, print-delivered environmental PE; N = 435, Web-based basic WB; N = 423, Web-based environmental WE; N = 432 and a waiting-list control group were studied in a clustered randomized controlled trial. Intervention costs were registered during the trial. Health care costs, participant costs and productivity losses were identified and compared with the intervention effects on PA in MET-hours per week and quality-adjusted life years QALYs 12 months after the start of the intervention. Cost-effectiveness ratios ICERs and cost-utility ratios ICURs were calculated per intervention condition. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty.

ResultsAs a whole i.e. the four intervention conditions together the Active Plus intervention was found to be cost-effective. The PB-intervention ICER = €-55-MET-hour, PE-intervention ICER = €-94-MET-hour and the WE-intervention ICER = €-139-MET-hour all resulted in higher effects on PA and lower societal costs than the control group. With regard to QALYs, the PB-intervention ICUR = €38,120-QALY, the PE-intervention ICUR = €405,892-QALY and the WE-intervention ICUR = €-47,293-QALY were found to be cost-effective when considering a willingness-to-pay threshold of €20,000-QALY. In most cases PE had the highest probability to be cost-effective.

ConclusionsThe Active Plus intervention was found to be a cost-effective manner to increase PA in a population aged over fifty when compared to no-intervention. The tailored Active Plus intervention delivered through printed material and with additional environmental information PE turned out to be the most cost-effective intervention condition as confirmed by the different sensitivity analyses. By increasing PA at relatively low costs, the Active Plus intervention can contribute to a better public health.

Trial registrationDutch Trial Register: NTR2297

KeywordsTailored intervention Older adults Physical activity Cost-effectiveness Cost-utility Quality of life Abbreviations95% CI95% Confidence interval

ANOVAUnivariate one-way analyses of variance

APActive plus

CControl group

CEACCost-effectiveness acceptability curve

CEAFCost-effectiveness acceptability frontiers

ICERCost-effectiveness ratio

ICURCost-utility ratio

LOCFLast observation carried forward

MHCMunicipal ‘health council

MVPAModerate to vigorous physical activity

NICENational Institute for Health and Clinical Excellence

NMBNet monetary benefit

PAPhysical activity

PBPrint-delivered basic intervention condition

PEPrint-delivered environmental intervention condition

QALYQuality adjusted life years

SDStandard deviation

SQUASHShort questionnaire to assess health enhancing physical activity

WBWeb-based basic intervention condition

WEWeb-based environmental intervention condition

WTPWillingness to pay

Electronic supplementary materialThe online version of this article doi:10.1186-s12966-014-0122-z contains supplementary material, which is available to authorized users.

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Autor: Rianne HJ Golsteijn - Denise A Peels - Silvia MAA Evers - Catherine Bolman - Aart N Mudde - Hein de Vries - Lilian Lech


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