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A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace.

Dallat MA, Hunter RF, Tully MA, Cairns KJ, Kee F - BMC Public Health (2013)

Bottom Line: Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer's perspective but further research is warranted to reduce uncertainty in our results.It is based on a sustainable "business model" which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, UK. mdallat01@qub.ac.uk.

ABSTRACT

Background: Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer's perspective.

Methods: Employees used a 'loyalty card' to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates.

Results: The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.

Conclusions: The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer's perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable "business model" which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges.

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Cost-effectiveness acceptability curves for QALYs gained for the Incentive and No Incentive Group.
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Figure 1: Cost-effectiveness acceptability curves for QALYs gained for the Incentive and No Incentive Group.

Mentions: Figure 1 shows a CEAC showing that at the cost-effectiveness threshold of £30,000/QALY the probability that the Incentive Group is cost-effective compared to the No Incentive Group is greater than 85%. No cost-effectiveness threshold exists for the business sector but from the CEAC in Figure 2 we see that when an employer is willing to pay at least £4,000 per percentage increase in productivity the probability that the Incentive Group is cost-effective compared to the No Incentive Group is approximately 50%.


A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace.

Dallat MA, Hunter RF, Tully MA, Cairns KJ, Kee F - BMC Public Health (2013)

Cost-effectiveness acceptability curves for QALYs gained for the Incentive and No Incentive Group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3852549&req=5

Figure 1: Cost-effectiveness acceptability curves for QALYs gained for the Incentive and No Incentive Group.
Mentions: Figure 1 shows a CEAC showing that at the cost-effectiveness threshold of £30,000/QALY the probability that the Incentive Group is cost-effective compared to the No Incentive Group is greater than 85%. No cost-effectiveness threshold exists for the business sector but from the CEAC in Figure 2 we see that when an employer is willing to pay at least £4,000 per percentage increase in productivity the probability that the Incentive Group is cost-effective compared to the No Incentive Group is approximately 50%.

Bottom Line: Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer's perspective but further research is warranted to reduce uncertainty in our results.It is based on a sustainable "business model" which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, UK. mdallat01@qub.ac.uk.

ABSTRACT

Background: Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer's perspective.

Methods: Employees used a 'loyalty card' to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates.

Results: The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.

Conclusions: The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer's perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable "business model" which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges.

Show MeSH
Related in: MedlinePlus