The cost-effectiveness of exercise referral schemes

Anokye, Nana K., Trueman, Paul, Green, Colin, Pavey, Toby G., Hillsdon, Melvyn and Taylor, Rod S. (2011) The cost-effectiveness of exercise referral schemes. BMC Public Health, 11 954.1-954.11. doi:10.1186/1471-2458-11-954

Author Anokye, Nana K.
Trueman, Paul
Green, Colin
Pavey, Toby G.
Hillsdon, Melvyn
Taylor, Rod S.
Title The cost-effectiveness of exercise referral schemes
Journal name BMC Public Health   Check publisher's open access policy
ISSN 1471-2458
Publication date 2011-12
Sub-type Article (original research)
DOI 10.1186/1471-2458-11-954
Open Access Status DOI
Volume 11
Start page 954.1
End page 954.11
Total pages 11
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: Exercise referral schemes (ERS) aim to identify inactive adults in the primary care setting. The primary care professional refers the patient to a third party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the patient. This paper examines the cost-effectiveness of ERS in promoting physical activity compared with usual care in primary care setting.
Methods: A decision analytic model was developed to estimate the cost-effectiveness of ERS from a UK NHS perspective. The costs and outcomes of ERS were modelled over the patient's lifetime. Data were derived from a systematic review of the literature on the clinical and cost-effectiveness of ERS, and on parameter inputs in the modelling framework. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses investigated the impact of varying ERS cost and effectiveness assumptions. Sub-group analyses explored the cost-effectiveness of ERS in sedentary people with an underlying condition.
Results: Compared with usual care, the mean incremental lifetime cost per patient for ERS was £169 and the mean incremental QALY was 0.008, generating a base-case incremental cost-effectiveness ratio (ICER) for ERS at £20,876 per QALY in sedentary individuals without a diagnosed medical condition. There was a 51% probability that ERS was cost-effective at £20,000 per QALY and 88% probability that ERS was cost-effective at £30,000 per QALY. In sub-group analyses, cost per QALY for ERS in sedentary obese individuals was £14,618, and in sedentary hypertensives and sedentary individuals with depression the estimated cost per QALY was £12,834 and £8,414 respectively. Incremental lifetime costs and benefits associated with ERS were small, reflecting the preventative public health context of the intervention, with this resulting in estimates of cost-effectiveness that are sensitive to variations in the relative risk of becoming physically active and cost of ERS.
Conclusions: ERS is associated with modest increase in lifetime costs and benefits. The cost-effectiveness of ERS is highly sensitive to small changes in the effectiveness and cost of ERS and is subject to some significant uncertainty mainly due to limitations in the clinical effectiveness evidence base.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article # 11

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Human Movement and Nutrition Sciences Publications
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