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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, Rhiannon Tudor, Linck, Pat, Hounsome, Natalia, Raisanen, Lawrence Matthew, Williams, Nefyn, Moore, Laurence Anthony Russell and Murphy, Simon 2013. Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial. BMC Public Health 13 (1) , 1021. 10.1186/1471-2458-13-1021

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Psychology
Social Sciences (Includes Criminology and Education)
Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Uncontrolled Keywords: Public health policy, Exercise referral, Mental health, Heart disease risk factors, Cost-effectiveness
Publisher: BioMed Central
ISSN: 1471-2458
Funders: Welsh Government, ESRC
Date of First Compliant Deposit: 30 March 2016
Last Modified: 14 Nov 2019 01:26
URI: http://orca.cf.ac.uk/id/eprint/55252

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