Abstract
Objectives: To assess the cost-effectiveness of workplace-delivered interventions designed to reduce sitting time as primary prevention measures for cardiovascular disease (CVD) in Australia. Methods: A Markov model was developed to simulate the lifetime cost-effectiveness of a workplace intervention for the primary prevention of CVD amongst office-based workers. An updated systematic review and a meta-analysis of workplace interventions that aim to reduce sitting time was conducted to inform the intervention effect. The primary outcome was workplace standing time. An incremental cost-effectiveness ratio (ICER) was calculated for this intervention measured against current practice. Costs (in Australia dollars) and benefits were discounted at 3% annually. Both deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. Results: The updated systematic review identified only one new study. Only the multicomponent intervention that included a sit-and-stand workstation showed statistically significant changes in the standing time compared to the control. The intervention was associated with both higher costs ($6820 versus $6524) and benefits (23.28 versus 23.27, quality-adjusted life year, QALYs), generating an ICER of $43,825/QALY. The DSA showed that target age group for the intervention, relative risk of CVD relative to the control and intervention cost were the key determinants of the ICER. The base case results were within the range of the 95% confidence interval and the intervention had a 85.2% probability of being cost-effective. Conclusions: A workplace-delivered intervention in the office-based setting including a sit-and-stand desk component is a cost-effective strategy for the primary prevention of CVD. It offers a new option and location when considering interventions to target the growing CVD burden.
Highlights
Cardiovascular disease (CVD) has been the dominant cause of mortality in Australia for the past several decades, with coronary heart disease (CHD) and stroke ranking the highest among the leading causes of death [1,2].CVD is considered largely preventable by modification of related risk factors, like smoking, obesity, physical inactivity, inadequate consumption of fruits and vegetables, high levels of blood glucose, blood pressure and lipids
The most recent systematic review of workplace interventions targeting sedentary activity compared the effectiveness of different interventions [22] which included one or more of the following components: i
If the intervention was scaled up to 20% of the national office-based workforce, it would result in a total gain of 4335 quality-adjusted life years (QALY) for an additional total cost of $267M
Summary
Cardiovascular disease (CVD) has been the dominant cause of mortality in Australia for the past several decades, with coronary heart disease (CHD) and stroke ranking the highest among the leading causes of death [1,2]. CVD is considered largely preventable by modification of related risk factors, like smoking, obesity, physical inactivity, inadequate consumption of fruits and vegetables, high levels of blood glucose, blood pressure and lipids. Ninety percent of Australian adults have at least one modifiable risk factor for CVD, while 64% have three or more [3]. Mortality due to CVD is expected to decline over time given advancements in prevention, early diagnosis and treatment, the total CVD burden is estimated to increase over the few decades given the ageing population[1]. Primary prevention offers the best option for tackling the growing prevalence of CVD worldwide
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