Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial

BMC Public Health

Simon Murphy¹  Laurence Moore¹  Nefyn Williams⁴  Larry Raisanen¹  Natalia Hounsome²  Pat Linck³  Rhiannon Tudor Edwards³ 

[1] DECIPHer, Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK;Centre for Primary Care and Public Health, Yvonne Carter Building, Queen Mary University of London, 58 Turner Street, London E1 2AB, UK;Centre for Health Economics & Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Dean Street Building, Bangor LL57 1UT, UK;North Wales Centre for Primary Care Research, Bangor University, College of Health and Behavioural Sciences, Brigantia Building, Bangor University, Bangor LL57 2UW, UK

关键词: Cost-effectiveness;    Heart disease risk factors;    Mental health;    Exercise referral;    Public health policy;   

Others  :  1161603
DOI  :  10.1186/1471-2458-13-1021

 received in 2013-02-06, accepted in 2013-10-14,  发布年份 2013

【 摘 要 】

Background

A recent HTA review concluded that there was a need for RCTs of exercise referral schemes (ERS) for people with a medical diagnosis who might benefit from exercise. Overall, there is still uncertainty as to the cost-effectiveness of ERS. Evaluation of public health interventions places challenges on conventional health economics approaches. This economic evaluation of a national public health intervention addresses this issue of where ERS may be most cost effective through subgroup analysis, particularly important at a time of financial constraint.

Method

This economic analysis included 798 individuals aged 16 and over (55% of the randomised controlled trial (RCT) sample) with coronary heart disease risk factors and/or mild to moderate anxiety, depression or stress. Individuals were referred by health professionals in a primary care setting to a 16 week national exercise referral scheme (NERS) delivered by qualified exercise professionals in local leisure centres in Wales, UK. Health-related quality of life, health care services use, costs per participant in NERS, and willingness to pay for NERS were measured at 6 and 12 months.

Results

The base case analysis assumed a participation cost of £385 per person per year, with a mean difference in QALYs between the two groups of 0.027. The incremental cost-effectiveness ratio was £12,111 per QALY gained. Probabilistic sensitivity analysis demonstrated an 89% probability of NERS being cost-effective at a payer threshold of £30,000 per QALY. When participant payments of £1 and £2 per session were considered, the cost per QALY fell from £12,111 (base case) to £10,926 and £9,741, respectively. Participants with a mental health risk factor alone or in combination with a risk of chronic heart disease generated a lower ICER (£10,276) compared to participants at risk of chronic heart disease only (£13,060).

Conclusions

Results of cost-effectiveness analyses suggest that NERS is cost saving in fully adherent participants. Though full adherence to NERS (62%) was higher for the economics sample than the main sample (44%), results still suggest that NERS can be cost-effective in Wales with respect to existing payer thresholds particularly for participants with mental health and CHD risk factors.

Trial registration

Current Controlled Trials ISRCTN47680448

【 授权许可】

   
2013 Edwards et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Wanless D: Securing Good Health for the Whole Population Final Report. http://webarchive.nationalarchives.gov.uk/+/http:/www.hmtreasury.gov.uk/media/D/3/Wanless04_summary.pdf webcite
• [2]Kelly MP, McDaid D, Ludbrook A, Powell J: Economic appraisal of public health interventions. http://www.nice.org.uk/nicemedia/documents/Economic_appraisal_of_public_health_interventions.pdf webcite
• [3]Weatherly H, Drummond M, Claxton K, Cookson R, Ferguson B, Godfrey C, Rice N, Sculpher M, Sowden A: Methods for assessing the cost-effectiveness of public health interventions: key challenges and recommendations. Health Policy 2009, 23:1-8.
• [4]Medical Research Council (MRC): Developing and evaluating complex interventions: new guidance. http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC004871 webcite
• [5]Payne C, McAllister M, Davies LM: Valuing the economic benefits of complex interventions when maximising health is not sufficient. Health Econ 2012. doi:10.1002/hec.2795 [Online First]
• [6]Cobiac LJ, Vos T, Barendregt JJ: Cost-effectiveness of interventions to promote physical activity: a modelling study. PLoS Med 2009, 14:e1000110. doi:10.1371/journal.pmed.1000110 [Online First]
• [7]Matrix: NICE Rapid review of the economic evidence of physical activity interventions. http://www.nice.org.uk/nicemedia/pdf/Physical_Activity_Economic_Review_April2006.pdf webcite
• [8]Pavey TG, Anokye N, Taylor AH, Trueman P, Moxham T, Fox KR, Hillsdon M, Green C, Campbell JL, Foster C, Mutrie N, Searle J, Taylor RS: The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess 2011, 15:1-254.
• [9]Munro JF, Nicholl JP, Brazier JE, Davey R, Cochrane T: Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial. J Epidemiol Community Health 2004, 58:1004-1010.
• [10]Owen L, Morgan A, Fischer A, Ellis S, Hoy A, Kelly MP: The cost effectiveness of public health interventions. J Public Health 2012, 34:37-45.
• [11]Murphy S, Raisanen L, Moore G, Edwards RT, Linck P, Williams N, Din NU, Hale J, Roberts C, McNaish E, Moore L: A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation. BMC Public Health 2010, 10:352. BioMed Central Full Text
• [12]Murphy SM, Edwards RT, Williams N, Raisanen L, Moore G, Linck P, Hounsome N, Din NU, Moore L: An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative. J Epidemiol Community Health 2012, 66:745-753.
• [13]Knapp M, Beecham J: Costing mental health services: the client service receipt inventory. Psychol Med 1990, 20:893-908.
• [14]EuroQol: User Guide version 2. http://www.euroqol.org/fileadmin/user_upload/Documenten/PDF/Folders_Flyers/EQ-5D-3L_UserGuide_2013_v5.0_October_2013.pdf webcite
• [15]Department of Health NHS Reference Costs 2007–08. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_098945 webcite
• [16]Curtis L: Unit Costs of Health and Social Care 2009. http://www.pssru.ac.uk/uc/uc2008contents.htm webcite
• [17]NHS Information Centre Prescribing Cost Analysis 2008 England. 2008. http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/prescriptions/prescription-cost-analysis-2008 webcite
• [18]Edwards RT, Hounsome B, Linck P, Russell IT: Economic evaluation alongside pragmatic randomised trials: developing a Standard Operating Procedure for clinical trials units. Trials 2008, 14:64-65.
• [19]Wales Index of Multiple Deprivation (WIMD) 2008. http://wales.gov.uk/topics/statistics/publications/wimd08la/?lang=en webcite
• [20]Sculpher M: Subgroups and heterogeneity in cost-effectiveness analysis. Pharmacoeconomics 2008, 26:799-806.
• [21]Willan AR: On the probability of cost-effectiveness using data from randomized clinical trials. BMC Med Res Methodol 2001, 1:8. BioMed Central Full Text
• [22]Nixon RM, Thompson SG: Methods for incorporating covariate adjustment, subgroup analysis and between-centre differences into cost-effectiveness evaluations. Health Econ 2005, 14:1217-1229.
• [23]Ioannidis JPA, Garber AM: Individualized cost-effectiveness analysis. PLoS Med 2011, 8:e1001058. doi:10.1371/journal.pmed.1001058 [Online First]
• [24]Espinoza M, Manca A, Claxton K, Sculpher MJ: The value of heterogeneity for cost-effectiveness subgroup analysis: theoretical framework and application. Value Health 2011, 14:A241.
• [25]Garrett S, Elley CR, Rose SB, O’Dea D, Lawton BA: Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence. Br J Gen Pract 2011, 61:e125-e133.
• [26]Anokye NK, Trueman P, Green C, Pavey TG, Hillsdon M, Taylor RS: The cost-effectiveness of exercise referral schemes. BMC Public Health 2011, 11:954. BioMed Central Full Text
• [27]Green LW, Glasgow RE: Evaluating the relevance, generalization, and applicability of research issues in external validation and translation methodology. Evaluation and the Health Professions 2006, 29:126-153.
• [28]Gusi N, Tomas-Carus P: Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther 2008, 10:R24. BioMed Central Full Text