Direct healthcare costs associated with device assessed and self-reported physical activity: results from a cross-sectional population-based study

Florian M Karl,Michael Laxy,Rolf Holle,Christa Meisinger,Annette Peters,Agnes Luzak,Maximilian Tremmel,Holger Schulz

doi:10.1186/s12889-018-5906-7

Abstract

BackgroundPhysical inactivity (PIA) is an important risk factor for many chronic conditions and therefore might increase healthcare utilization and costs. This study aimed to analyze the association of PIA using device assessed and self-reported physical activity (PA) data with direct healthcare costs.MethodsCross-sectional data was retrieved from the population based KORA FF4 study (Cooperative Health Research in the Region of Augsburg) that was conducted in southern Germany from 2013 to 2014 (n = 2279). Self-reported PA was assessed with two questions regarding sports related PA in summer and winter and categorized into “high activity”, “moderate activity”, “low activity” and “no activity”. In a subsample (n = 477), PA was assessed with accelerometers and participants were categorized into activity quartiles (“very high”, “high”, “low” and “very low”) according to their mean minutes per day spent in light intensity, or in moderate-vigorous PA (MVPA). Self-reported healthcare utilization was used to estimate direct healthcare costs. We regressed direct healthcare costs on PA using a two-part gamma regression, adjusted for age, sex and socio-demographic variables. Additional models, including and excluding potential additional confounders and effect mediators were used to check the robustness of the results.ResultsAnnual direct healthcare costs of individuals who reported no sports PA did not differ from those who reported high sports PA [+€189, 95% CI: -188, 598]. In the subsample with accelerometer data, participants with very low MVPA had significantly higher annual costs than participants with very high MVPA [+€986, 95% CI: 15, 1982].ConclusionDevice assessed but not self-reported PIA was associated with higher direct healthcare costs. The magnitude and significance of the association depended on the choice of covariates in the regression models. Larger studies with device assessed PA and longitudinal design are needed to be able to better quantify the impact of PIA on direct healthcare costs.

Highlights

Physical inactivity (PIA) is an important risk factor for many chronic conditions and might increase healthcare utilization and costs
Assessment of physical activity Questionnaire Sports related PA was assessed by two questions: “How often do you exercise during winter?” and, “How often do you exercise during summer?”
When adjusted for age, age2, sex, education and equivalence income (Model A) the excess direct healthcare costs were insignificantly higher [€189, 95% Confidence Interval (CI): -188, 598] in reference to the subjects with high activity in sports [€1700, 95% CI: 1423, 1996]

Summary

Introduction

Physical inactivity (PIA) is an important risk factor for many chronic conditions and might increase healthcare utilization and costs. Previous studies have estimated the percentage of direct healthcare costs associated with PIA using a population-attributable fraction approach that combines risk, prevalence, and aggregate cost estimates from various sources [5,6,7,8,9,10]. Allender et al [5] used information from the WHO global burden of disease report of 2002 and concluded that the costs of PIA due to mortality and morbidity to the National Health Service in the UK is £1.06 billion annually. Another approach to calculate direct healthcare costs is to use individual data linked to healthcare expenditure data. Inactive subjects had $1437 higher overall direct healthcare costs as compared to active

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