Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study

Eelco Ab Over,Heleen H Reenen,Matthijs Van Den Berg,Luqman Tariq,Gc Wendel-Vos,Rudolf T Hoogenveen,Pieter Hm Van Baal

doi:10.1186/1478-7547-10-13

Abstract

BackgroundCounseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general practitioner in the Netherlands.MethodsWe used the RIVM chronic disease model to estimate the long-term effects of increased physical activity on the future health care costs and quality adjusted life years (QALY) gained, from a health care perspective.ResultsThe intervention resulted in almost 6000 people shifting to more favorable physical-activity levels, and in 5100 life years and 6100 QALYs gained, at an additional total cost of EUR 67.6 million. The incremental cost-effectiveness ratio (ICER) was EUR 13,200 per life year gained and EUR 11,100 per QALY gained. The intervention has a probability of 0.66 to be cost-effective if a QALY gained is valued at the Dutch informal threshold for cost-effectiveness of preventive intervention of EUR 20,000. A sensitivity analysis showed substantial uncertainty of ICER values.ConclusionCounseling in combination with pedometer use aiming to increase physical activity may be a cost-effective intervention. However, the intervention only yields relatively small health benefits in the Netherlands.

Highlights

Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes
We assumed that the percentage of General practitioner (GP) participating in the pedometer intervention would be equal to the percentage that opportunistically offers a minimal smokingcessation intervention in the Netherlands, namely 35%-40% [11]
The pedometer scenario resulted in 4,600 life years or 5,500 quality adjusted life years (QALY) gained compared to the current practice scenario

Summary

Introduction

Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. A meta-analysis by Bravata et al [4] of eight randomized controlled trials showed an average increase of 2491 (95% C.I. 1098 – 3885) steps per day among insufficiently-active outpatient adults and sedentary healthy adults randomly assigned to pedometer use for a mean period of 18 weeks (range: 3–104 weeks). These pedometer interventions, of which about two thirds included additional physical activity counseling, improved the patients’ risk factor profiles: on average, body mass index decreased by 0.38 kg/m2, systolic blood pressure by 3.8 mmHg and diastolic blood pressure by 0.3 mmHg

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Discussion

Conclusion