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

Edwards RT, Linck P, Hounsome N, Raisanen L, Williams N, Moore L, Murphy S - BMC Public Health (2013)

Bottom Line: The incremental cost-effectiveness ratio was £12,111 per QALY gained.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Health Economics & Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Dean Street Building, Bangor LL57 1UT, UK. r.t.edwards@bangor.ac.uk.

ABSTRACT

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.

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Related in: MedlinePlus

Cost-effectiveness planes with 1,000 bootstrapped ICER estimates for NERS economic evaluation. Cost-effectiveness planes for base case (A), cost-effectiveness acceptability curves for three intervention costs of £285, £385 (base case) and £579 (B), and for participant subgroups with different referral reason to NERS (C), adherence to NERS (D), gender (E), and age of participants (F).
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Figure 1: Cost-effectiveness planes with 1,000 bootstrapped ICER estimates for NERS economic evaluation. Cost-effectiveness planes for base case (A), cost-effectiveness acceptability curves for three intervention costs of £285, £385 (base case) and £579 (B), and for participant subgroups with different referral reason to NERS (C), adherence to NERS (D), gender (E), and age of participants (F).

Mentions: The base case analysis produced a mean difference in cost of £327 and a mean difference in QALY gains of 0.027 between groups, indicating NERS was more expensive and more effective compared to the control. The incremental cost-effectiveness ratio (ICER) was £12,111 per QALY gained. Figure 1 shows the cost-effectiveness plane with 1,000 bootstrapped ICER estimates. The figure demonstrates that the majority of simulations fell in the north-east quadrant of the cost-effectiveness plane, where the intervention is more expensive and more effective compared to the control condition.


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

Edwards RT, Linck P, Hounsome N, Raisanen L, Williams N, Moore L, Murphy S - BMC Public Health (2013)

Cost-effectiveness planes with 1,000 bootstrapped ICER estimates for NERS economic evaluation. Cost-effectiveness planes for base case (A), cost-effectiveness acceptability curves for three intervention costs of £285, £385 (base case) and £579 (B), and for participant subgroups with different referral reason to NERS (C), adherence to NERS (D), gender (E), and age of participants (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231449&req=5

Figure 1: Cost-effectiveness planes with 1,000 bootstrapped ICER estimates for NERS economic evaluation. Cost-effectiveness planes for base case (A), cost-effectiveness acceptability curves for three intervention costs of £285, £385 (base case) and £579 (B), and for participant subgroups with different referral reason to NERS (C), adherence to NERS (D), gender (E), and age of participants (F).
Mentions: The base case analysis produced a mean difference in cost of £327 and a mean difference in QALY gains of 0.027 between groups, indicating NERS was more expensive and more effective compared to the control. The incremental cost-effectiveness ratio (ICER) was £12,111 per QALY gained. Figure 1 shows the cost-effectiveness plane with 1,000 bootstrapped ICER estimates. The figure demonstrates that the majority of simulations fell in the north-east quadrant of the cost-effectiveness plane, where the intervention is more expensive and more effective compared to the control condition.

Bottom Line: The incremental cost-effectiveness ratio was £12,111 per QALY gained.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Health Economics & Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Dean Street Building, Bangor LL57 1UT, UK. r.t.edwards@bangor.ac.uk.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus