Table 3.
Cost-effectiveness studies undertaken of interventions that included physical activity counselling or intervention within primary care or the community (published from 2002 to 2009).
| Outcome | ||||||||
|---|---|---|---|---|---|---|---|---|
| Study details and quality | Objective; economic perspective | Study type; economic analysis type | Interventions (I) and comparison (C) | Participants, number in each group | Follow-up duration (months) | Annual cost per participant to become active, (€at time of study) [inflated to June 2008] | Cost of shifting to active categorya, (€at time of study) [inflated to June 2008] | Cost per QALY (€ at time of study) [inflated to June 2008] |
| UK Beam Trial Team,17 UK: Excellent | Primary care, multifaceted intervention for low back pain; health funder, 2000–2001 | RCT; CUA | I1: exercise programme; I2: spinal manipulation; I3: combined; C: usual care | Participants consulting GP for low back pain: I1: 297 | 12 | £8235b (€13 423) [€15 860] | ||
| I2: 342 | ||||||||
| I3: 322 | ||||||||
| C: 326 | ||||||||
| Cochrane et al,18 UK: Excellent | Primary care/community water exercise programme; societal costs, 2002 | RCT; CEA | I1: water-based exercise, C: usual care | Older participants with hip and/or knee OA: I1: 153 | 12 | £5008c (€7963) [€9160] | ||
| C: 159 | ||||||||
| Hurley et al,19 UK: Excellent | Primary care, Knee rehabilitation; societal costs, 2003 | Cluster RCT; CEA, CUA | I1: individual rehabilitation,d I2: group-based rehabilitation,d C: usual primary care | Participants ≥50 years attending primary care for mild/moderate/severe knee pain, duration >6 months: I1: 146 | 6 | Usual care produced greater QALY gain (0.0096) than individual rehabilitation (−0.0034) and group rehabilitation (0.0057), despite ‘functional improvements’ with exercise interventions | ||
| I2: 132 | ||||||||
| C: 140 | ||||||||
| Hollinghurst et al,20 UK: Fair | Primary care; societal perspective, 2005 | 4 × 2 factorial RCT; CEA | I1: short-course Alexander technique, I2: long-course Alexander technique, I3: massage, C: usual care groups; All also randomised into with or without GP exercise script and practice nurse exercise counselling | Participants with chronic or recurrent low back pain: I1: 144 | 12 | £2847 (€4157) [€4577] (exercise counselling and prescription for exercise compared with usual care) | ||
| I2: 144 | ||||||||
| I3: 147 | ||||||||
| C: 144 | ||||||||
| Gusi et al,21 Spain: Poor | Primary care, supervised walking programme; health funder, 2005 | RCT; CUA | I1: walking-based, supervised programme (3 × 50 min/week), C: usual care | Women, ≥60 years with moderate depression or overweight: I1: 64 | 6 | €311 [€348] | ||
| C: 63 | ||||||||
| Handley et al,22 US: Fair | Primary care-based automated telephone support; direct programme costs, June 2003 to December 2004 | RCT; CEA, CUA | I1: automated telephone surveillance/support, nurse care management, C: usual care | Adult English-, Spanish-, Cantonese-speaking primary care participants with type 2 diabetes: I1: 112 | 12 | US $558e (€463) [€551] | US $65 167 (€54 089), [€64 346] | |
| C: 114 | ||||||||
| Sevick et al,23 US: Excellent | Community, physical activity counselling; health funder, 2004 | RCT; CEA | I1: telephone-based feedback on PAf, I2: print-based feedback on PA, C: contact control | Sedentary adults (18-65 years): I1: 80 | 12 | $3967 (€3174) [€3673] (phone group); $955 (€764) [€884] (print group) | ||
| I2: 81 | ||||||||
| C: 78 | ||||||||
| Munro et al,24 UK: Poor | Primary care, exercise class; health funder, 2003/2004 | Cluster RCT; CUA, CEA | I1: free, 2 × weekly (45 min) community-based exercise class, C: usual care | Participants ≥65 years assessed by survey as being in least-active four-fifths of the population: I1: 2283 | 24 | €17 174 [€19 425] | ||
| C: 4137 | ||||||||
| Dzator et al,25 Australia: Fair | Physical activity/nutrition programme in community setting; direct programme costs | RCT; CEA | I1: high-level, interactive group sessions, I2: low-level, mailed intervention, C: no intervention | Couplesh (mean age 28–31 years): I1: 47 couples | 12 | No significant effect difference between groups observed regarding the activity level: exercise days per week | AUS $460.44 (€267) [€350] (high level); AUS $458.61 (€266) [€349] (low level) | |
| I2: 47 couples | ||||||||
| C: 43 couples | ||||||||
| Elley et al,11 New Zealand: Excellent | Primary care exercise counselling/prescription; societal costs, 2001 | Cluster RCT; CEA | I1: Green Prescription, counselling in general practice, C: usual care | Less active primary care participants (40–79 years): I1: 451 | 12 | €825 [€957] (activity level 5 × 30 min/week) | NZ $1756g (€825) [€957] | |
| C: 427 | ||||||||
| Dalziel et al,10 New Zealand: Excellent | Primary care exercise counselling/prescription data from Elley's study;11 2001 costs | Cluster RCT; CUA | I1: Green Prescription, counselling in general practice, C: usual care | Less-active primary care participants (40–79 years): I1: 451 | 12 | NZ$2053 (€965) [€1120] | ||
| C: 427 | ||||||||
| Isaacs et al,26 UK Good | Primary care referral to exercise programmes; health funder, 2002 costs | RCT; CEA | I1: supervised, gym-based exercise classes,i I2: instructor-led walking programme,i C: advice and information only | Physically inactive 40–74 year olds with at least one cardiovascular risk factor: I1 317 | 12 | I1: £19 500 (€31 005) [€35 665]; I2: £47 500 (€75 525) [€86 877] | ||
| I2: 311 | ||||||||
| C: 315 | ||||||||
| Elley et al,27 New Zealand: Excellent | Primary care exercise counselling/prescription; societal costs, 2008 | RCT; CEA | I1: enhanced Green Prescription, counselling in primary care, C: usual care | Physically inactive 40–74-year-old women | 24 | NZ $687 [€331] sustained at 12 months; NZ $1407 [€678] sustained at 24 months | ||
a
Undertaking at least 150 minutes of at least moderate-intensity physical activity per week.
b
Exercise programme component only.
c
20% (n = 65) missing values for EuroQol-5D (EQ-5D) imputed by regression based on age, sex, and EuroQol-Visual Analogue Scale (EQ-VAS).
d
12 supervised sessions, 2 × weekly for 6 weeks (40 minutes to 1 hour) including information giving and exercises.
e
Cost to achieve a 10% increase in the proportion of participants achieving moderate or vigorous physical activity.
f
No significant difference between phone and control group at 12 months for PA measures.
g
Programme cost of shifting one person from sedentary to active category.
h
Variable proportion of participants reported as sufficiently active at baseline.
i
Ten-week (2–3 times per week).
CEA = cost-effectiveness analysis. CUA = cost-utility analysis. OA = osteoarthritis. PA = physical activity. QALY = quality-adjusted life-year. RCT = randomised controlled trial.