Long-term health outcomes and cost-effectiveness of a computer-tailored physical activity intervention among people aged over fifty: modelling the results of a randomized controlled trial

BMC Public Health

Lilian Lechner³  Hein de Vries¹  Gerrie CW Wendel-Vos⁴  Aart N Mudde³  Catherine Bolman³  Rianne HJ Golsteijn³  Talitha L Feenstra²  Rudolf R Hoogenveen⁴  Denise A Peels³ 

[1]Caphri School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands

[2]University Medical Centre Groningen, Groningen, The Netherlands

[3]Department of Psychology and Educational Sciences, Open University of the Netherlands, PO Box 2960, 6401 DL Heerlen, The Netherlands

[4]Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

关键词: Web-based;    Print-delivered;    Tailored intervention;    Physical activity;    Disease incidence;    Quality of life;    Modelling;    Cost-effectiveness;   

Others  :  1125960
DOI  :  10.1186/1471-2458-14-1099

 received in 2014-07-09, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

Physical inactivity is a significant predictor of several chronic diseases, becoming more prevalent as people age. Since the aging population increases demands on healthcare budgets, effectively stimulating physical activity (PA) against acceptable costs is of major relevance. This study provides insight into long-term health outcomes and cost-effectiveness of a tailored PA intervention among adults aged over fifty.

Methods

Intervention participants (N = 1729) received tailored advice three times within four months, targeting the psychosocial determinants of PA. The intervention was delivered in different conditions (i.e. print-delivered versus Web-based, and with or without additional information on local PA opportunities). In a clustered RCT, the effects of the different intervention conditions were compared to each other and to a control group. Effects on weekly Metabolic Equivalents (MET)-hours of PA obtained one year after the intervention started were extrapolated to long-term outcomes (5-year, 10-year and lifetime horizons) in terms of health effects and quality-adjusted life years (QALYs) and its effect on healthcare costs, using a computer simulation model. Combining the model outcomes with intervention cost estimates, this study provides insight into the long-term cost-effectiveness of the intervention. Incremental cost-effectiveness ratios (ICERs) were calculated.

Results

For all extrapolated time horizons, the printed and the Web-based intervention resulted in decreased incidence numbers for diabetes, colon cancer, breast cancer, acute myocardial infarctions, and stroke and increased QALYs as a result of increased PA. Considering a societal Willingness-to-Pay of €20,000/QALY, on a lifetime horizon the printed (ICER = €7,500/QALY) as well as the Web-based interventions (ICER = €10,100/QALY) were cost-effective. On a 5-year time horizon, the Web-based intervention was preferred over the printed intervention. On a 10-year and lifetime horizon, the printed intervention was the preferred intervention condition, since the monetary savings of the Web-based intervention did no longer outweigh its lower effects. Adding environmental information resulted in a lower cost-effectiveness.

Conclusion

A tailored PA intervention in a printed delivery mode, without environmental information, has the most potential for being cost-effective in adults aged over 50.

Trial registration

The current study was registered at the Dutch Trial Register (NTR2297; April 26th 2010).

【 授权许可】

   
2014 Peels et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT: Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012, 380(9838):219-229.
• [2]World Health Organization: Health and Development through Physical Activity and Sport. Geneva: WHO Document Production Services; 2003.
• [3]Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U: Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012, 380:247-257.
• [4]WHO Europe: Steps to health: a european framework to promote physical activity for health. Copenhagen: WHO Europe; 2007.
• [5]Oldridge NB: Economic burden of physical inactivity: healthcare costs associated with cardiovascular disease. Eur J Cardiovasc Prev Rehabil 2008, 15(2):130-139.
• [6]Colman R, Walker S: The cost of physical inactivity in British Columbia. In Genuine Progress Index for Atlantic Canada - Measuring sustainable development. Glen Haven: Ministry of Health Planning; 2004.
• [7]Hagberg L: Cost-effectiveness of the promotion of physical activity in health care. Umea: Umea University; 2007.
• [8]Sevick MA, Dunn AL, Morrow MS, Marcus BH, Chen GJ, Blair SN: Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults. Results from project ACTIVE. Am J Prev Med 2000, 19(1):1-8.
• [9]Garrett S, Elley CR, Rose SB, O’Dea D, Lawton BA, Dowell AC: Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence. Br J Gen Pract 2011, 61(584):e125-133.
• [10]Global Strategy on Diet, Physical Activity and Health. [http://www.who.int/dietphysicalactivity/pa/en/index.html# webcite]
• [11]King AC, Rejeski WJ, Buchner DM: Physical activity interventions targeting older adults. A critical review and recommendations. Am J Prev Med 1998, 15(4):316-333.
• [12]Ackermann RT, Cheadle A, Sandhu N, Madsen L, Wagner EH, LoGerfo JP: Community exercise program use and changes in healthcare costs for older adults. Am J Prev Med 2003, 25(3):232-237.
• [13]Woodcock J, Franco OH, Orsini N, Roberts I: Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. Int J Epidemiol 2011, 40(1):121-138.
• [14]Noar SM, Benac CN, Harris MS: Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull 2007, 133(4):673-693.
• [15]Krebs P, Prochaska JO, Rossi JS: A meta-analysis of computer-tailored interventions for health behaviour change. Prev Med 2010, 51:214-221.
• [16]Peels DA, Bolman C, Golsteijn RHJ, De Vries H, Mudde AN, Van Stralen MM, Lechner L: Long-term efficacy of a tailored physical activity intervention among older adults. Int J Behav Nutr Phys Act 2013, 10:104. BioMed Central Full Text
• [17]Van Stralen MM, Kok G, De Vries H, Mudde AN, Bolman C, Lechner L: The Active Plus protocol: systematic development of two theory and evidence-based tailored physical activity interventions for the over-fifties. BMC Public Health 2008, 8:399. BioMed Central Full Text
• [18]Peels DA, Van Stralen MM, Bolman C, Golsteijn RHJ, De Vries H, Mudde AN, Lechner L: The Development of a Web-Based Computer Tailored Advice to Promote Physical Activity Among People Older Than 50 Years. J Med Internet Res 2012, 14(2):e39.
• [19]Hoogenveen RT, van Baal PH, Boshuizen HC: Chronic disease projections in heterogeneous ageing populations: approximating multi-state models of joint distributions by modelling marginal ditributions. Math Med Biol 2010, 27(1):1-19.
• [20]Ammann R, Vandelanotte C, De Vries H, Mummery K: Can a Website-delivered computer-tailored physical activity intervention be acceptable, usable, and effective in older people? Health Educ & Behav 2013, 40(2):160-170.
• [21]Peels DA, Bolman C, Golsteijn RHJ, De Vries H, Mudde AN, Van Stralen MM, Lechner L: Differences in Reach and Attrition between Web-based or Print-delivered Tailored Interventions among Adults aged over Fifty. J Med Internet Res 2012, 14(6):e179.
• [22]Roux L, Pratt M, Tengs TO, Yore MM, Yanagawa TL, Va Den Bosch J, Rutt C, Brownson RC, Powell KE, Heath G, Kohl HW 3rd, Teutsch S, Cawley J, Lee IM, West L, Buchner DM: Cost effectiveness of community-based physical activity interventions. Am J Prev Med 2008, 35(6):578-588.
• [23]Graves N, Barnett AG, Halton K, Veerman J, Winkler E, Owen N, Reeves MM, Marshall A, Eakin E: Cost-effectiveness of a telephone-delivered intervention for physical activity and diet. PLoS One 2009, 4(9):e7135.
• [24]Gulliford M, Charlton J, Bhattarai N, Rudisill C: Social and material deprivation and the cost-effectiveness of an intervention to promote physical activity: cohort study and Markov model. J Public Health (Oxf) 2014. Epub ahead of print
• [25]Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME: Planning health promotyion programs: an intervention mapping approach. 3rd edition. San Francisco: Jossey-Bass; 2011.
• [26]De Vries H, Mesters I, Riet JV, Willems K, Reubsaet A: Motives of Belgian Adolescents for Using Sunscreen: The Role of Action Plans. Cancer Epidemiol Biomarkers Prev 2006, 15(7):1360-1366.
• [27]Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 1983, 51(3):390-395.
• [28]Schwarzer R: The Health Action Approach (HAPA). 2009.
• [29]Weinstein ND: The precaution adoption process. Health Psychol 1988, 7(4):355-386.
• [30]Baumeister RF, Vohs KD: Handbook of self-regulation: research, theory, and applications. New York: The Guilford Press; 2004.
• [31]Ryan R, Deci E: Active human nature: self-determination theory and the promotion and maintenance of sport, exercise and health. In Intrinsic motivation and self-determination in exercise and sport. Edited by Hagger MS, Chatzisarantis NLD. Champaign: Human Kinatics Europe Ltd; 2007:1-19.
• [32]Owen N, Humpel N, Leslie E, Bauman A, Sallis JF: Understanding environmental influences on walking: Review and research agenda. Am J Prev Med 2004, 27(1):67-76.
• [33]Humpel N, Owen N, Iverson D, Leslie E, Bauman A: Perceived environment attributes, residential location and walking for particular purposes. Am J Prev Med 2004, 26(2):119-125.
• [34]Humpel N, Marshall AL, Leslie E, Bauman A, Owen N: Changes in neighborhood walking are related to changes in perceptions of environmental attributes. Ann Behav Med 2004, 27(1):60-67.
• [35]Sallis JF, King AC, Sirard JR, Albright CL: Perceived environmental predictors of physical activity over 6 months in adults: activity counseling trial. Health Psychol 2007, 26(6):701-709.
• [36]Kremers SP, De Bruijn GJ, Droomers M, Van Lenthe F, Brug J: Moderators of environmental intervention effects on diet and activity in youth. Am J Prev Med 2007, 32(2):163-172.
• [37]Harrington DW, Elliot SJ: Weighing the importance of neighbourhood: a multilevel exploration of the determinants of overweight and obesity. Soc Sci Med 2009, 68(4):593-600.
• [38]De Bourdeaudhuij I, Sallis JF, Saelens BE: Environmental correlates of physical activity in a sample of Belgian adults. Am J Health Promot 2003, 18(1):83-92.
• [39]Hobbs N, Godfrey A, Lara J, Errington L, Meyer TD, Rochester L, White M, Methers JC, Sniehotta FF: Are behavioural interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis. BMC Medicine 2013, 11:75. BioMed Central Full Text
• [40]Van Stralen MM, De Vries H, Mudde AN, Bolman C, Lechner L: The Long-Term Efficacy of Two Computer-Tailored Physical Activity Interventions for Older Adults: Main Effects and Mediators. Health Psychol 2011, 30(4):442-452.
• [41]Van Stralen MM, De Vries H, Mudde AN, Bolman C, Lechner L: Efficacy of Two Tailored Interventions Promoting Physical Activity in Older Adults. Am J Prev Med 2009, 37(5):405-417.
• [42]Peels DA, De Vries H, Bolman C, Golsteijn RHJ, Van Stralen MM, Mudde AN, Lechner L: Differences in the use and appreciation of a Web-based or printed computer tailored physical activity intervention for people aged over fifty. Health Educ Res 2013, 28(4):715-731.
• [43]Wendel-Vos GCW, Schuit AJ, Saris WH, Kromhout D: Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 2003, 56(12):1163-1169.
• [44]Van Baal PHM, Feenstra TL, Hoogenveen RT, De Wit GA: Cost effectiveness analysis with the RIVM Chronic Disease Model. Bilthoven: RIVM; 2005. Report No 260706002
• [45]Van Baal PHM, Polder J, De Wit GA, Hoogenveen RT, Feenstra TL, Boshuizen H, Engelfriet P, Brouwer WBF: Lifetime medical costs of obesity: prevention no cure for increasing health expenditure. PLoS Med 2008, 5:e29.
• [46]Van Baal PHM, Feenstra TL, Hoogenveen RT, De Wit GA, Brouwer WBF: Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a ‘perfect’ cost-utility ratio. Health Econ 2007, 16(4):421-433.
• [47]R Development Core Team: R: A language and environment for statistical computing, vol. ISBN 3-900051-07-0. Vienna, Austria: R Foundation for Statistical Computing; 2008. URL http://www.R-project.org webcite
• [48]Sahlqvist S, Song Y, Bull F, Adams E, Preston J, Ogilvie D: Effect of questionnaire length, personalisation and reminder type on response rate to a complex postal survey: randomised controlled trial. BMC Med Res Methodol 2011, 11:62. BioMed Central Full Text
• [49]Edwards PJ, Roberts I, Clarke MJ, DiGuiseppi C, Wentz R, Kwan I, Cooper R, Felix LM, Pratap S: Methods to increase response to postal and electronic questionnaires (Review). Cochrane Database Syst Rev 2009, 3:MR000008.
• [50]Bemelmans WJE, Wendel-Vos GCW, Bogers RP, Milder IEJ, De Hollander EL, Barte JCM, Tariq L, Jacobs-van der Bruggen MAM: Kosteneffectiviteit beweeg- en dieetadvisering bij mensen met (hoog risico op) diabetes mellitus type 2: Literatuuronderzoek en modelsimulaties rondom de beweegkuur. Edited by RIVM. Bilthoven: RIVM; 2008.
• [51]Lee KJ, Simpson JA: Introduction to multiple imputation for dealing with missing data. Respirology 2014, 19:162-167.
• [52]Schulz K, Altman D, Moher D: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Br Med J 2010, 340:c322.
• [53]Golsteijn RHJ, Peels DA, Evers SMAA, Bolman C, Mudde AN, De Vries H, Lechner L: 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 intervention. Int J Behav Nutr Phys Act 2014, 11:122. BioMed Central Full Text
• [54]Hakkaart-van Roijen L, Tan S, Bouwmans C: Handleiding voor kostenonderzoek: Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg (in Dutch). Rotterdam: College voor Zorgverzekeringen; 2010.
• [55]RVZ: Zinnige en duurzame zorg: transparante keuzen in de zorg voor een houdbaar zorgstelsel. Zoetermeer: Raad voor de Volksgezondheid en Zorg; 2006.
• [56]Baio G, Dawid A: Probabilistic sensitivity analysis in health economics. Stat Methods Med Res 2011. 10.1177/0962280211419832
• [57]Tate DF, Finkelstein EA, Khavjou O: Cost effectiveness of internet interventions: review and recommendations. Ann Behav Med 2009, 38:40-45.
• [58]Lewis B, Williams D, Neighbors C, Jakicic J, Marcus B: Cost analysis of internet vs. print interventions for physical activity promotion. Psychol Sport Exerc 2010, 11(3):246-249.
• [59]Muller-Riemenschneider F, Reinhold T, Willich S: Cost-effectiveness of interventions promoting physical activity. Br J Sports Med 2009, 43:70-76.
• [60]Wu S, Cohen D, Shi Y, Pearson M, Sturm R: Economic analysis of physical activity interventions. Am J Prev Med 2011, 40(2):149-158.
• [61]McAuley E, Morris KS, Motl RW, Hu L, Konopack JF, Elavsky S: Long-term follow-up of physical activity behaviour in older adults. Health Psychol 2007, 26(3):375-380.
• [62]Orchard TJ, Temprosa M, Barrett-Conno E, Fowler SE, Goldberg RB, Mather KJ, Marcovina SM, Montez M, Ratner RE, Saudek CD, Sherif H, Watson KE: Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study. Diabet Med 2012, 30(1):46-55.
• [63]Helmerhorst HJF, Brage S, Warren J, Besson H, Ekelund U: A systematic review of reliability and objective criterion-related validity of physical activity questionnaires. Int J Behav Nutr Phys Act 2012, 9:103. BioMed Central Full Text
• [64]Department of Health: At least five a week: Evidence on the impact of physical activity and its relationship to health. London: Department of Health; 2004.
• [65]Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C: Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007, 39(8):1435-1445.
• [66]Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A: Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association. Circulation 2007, 116(9):1081-1093.
• [67]Janssen I, Jollife CJ: Influence of physical activity on mortality in elderly with coronary artery disease. Med Sci Sports Exerc 2006, 38(3):418-423.
• [68]Kesaniemi YK, Danforth EJ, Jensen MD, Kopelman PG, Lefèbvre P, Reeder B: Dose-response issues concerning physical activity and health: an evidence-based symposium. Med Sci Sports Exerc 2001, 33(6):S351-S358.
• [69]TNO Kwaliteit van Leven: Trendrapport Bewegen en Gezondheid 2004/2005. Leiden: De Bink; 2007.