Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes : an economic evaluation of the 48-month PROPELS randomized controlled trial
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
INTRODUCTION: Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D.
MATERIALS AND METHODS: We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective.
RESULTS: Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years.
CONCLUSIONS: We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect.
TRIAL REGISTRATION NUMBER: ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
BMJ open diabetes research & care - 12(2024), 2 vom: 12. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Heathcote, Laura Ellen [VerfasserIn] |
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| Links: |
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| Themen: |
Behavior |
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| Anmerkungen: |
Date Completed 14.03.2024 Date Revised 15.03.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/bmjdrc-2023-003516 |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Heathcote, Laura Ellen |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes |b an economic evaluation of the 48-month PROPELS randomized controlled trial |
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| 500 | |a Date Revised 15.03.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a INTRODUCTION: Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D | ||
| 520 | |a MATERIALS AND METHODS: We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective | ||
| 520 | |a RESULTS: Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years | ||
| 520 | |a CONCLUSIONS: We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect | ||
| 520 | |a TRIAL REGISTRATION NUMBER: ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Behavior | |
| 650 | 4 | |a Costs and Cost Analysis | |
| 650 | 4 | |a Diabetes Mellitus, Type 2 | |
| 650 | 4 | |a Self-Management | |
| 700 | 1 | |a Pollard, Daniel J |e verfasserin |4 aut | |
| 700 | 1 | |a Brennan, Alan |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Melanie J |e verfasserin |4 aut | |
| 700 | 1 | |a Eborall, Helen |e verfasserin |4 aut | |
| 700 | 1 | |a Edwardson, Charlotte L |e verfasserin |4 aut | |
| 700 | 1 | |a Gillett, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Gray, Laura J |e verfasserin |4 aut | |
| 700 | 1 | |a Griffin, Simon J |e verfasserin |4 aut | |
| 700 | 1 | |a Hardeman, Wendy |e verfasserin |4 aut | |
| 700 | 1 | |a Henson, Joseph |e verfasserin |4 aut | |
| 700 | 1 | |a Khunti, Kamlesh |e verfasserin |4 aut | |
| 700 | 1 | |a Sharp, Stephen |e verfasserin |4 aut | |
| 700 | 1 | |a Sutton, Stephen |e verfasserin |4 aut | |
| 700 | 1 | |a Yates, Thomas |e verfasserin |4 aut | |
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