Abstract
ObjectivesIncreasing physical activity reduces the risk of chronic illness including Type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle interventions can increase physical activity but few successfully engage men. This study aims to investigate the 5 year cost-effectiveness of EuroFIT, a program to improve physical activity tailored specifically for male football (soccer) fans compared to a no intervention comparison group.MethodsWe developed a Markov cohort model in which the impact of improving physical activity on five chronic health conditions (colorectal cancer, Type 2 diabetes, coronary heart disease, stroke and depression) and mortality was modelled. We estimated costs from a societal perspective and expressed benefits as quality adjusted life years (QALYs). We obtained data from a 4-country (England, Netherlands, Portugal and Norway) pragmatic randomised controlled trial evaluating EuroFIT, epidemiological and cohort studies, and meta-analyses. We performed deterministic and probabilistic sensitivity analyses to assess the impact of uncertainty in the model’s parameter values on the cost-effectiveness results. We used Monte Carlo simulations to estimate uncertainty and presented this using cost-effectiveness acceptability curves (CEACs). We tested the robustness of the base case analysis using five scenario analyses.ResultsAverage costs over 5 years per person receiving EuroFIT were €14,663 and per person receiving no intervention €14,598. Mean QALYs over 5 years were 4.05 per person for EuroFIT and 4.04 for no intervention. Thus, the average incremental cost per person receiving EuroFIT was €65 compared to no intervention, while the average QALY gain was 0.01. This resulted in an ICER of €5206 per QALY gained. CEACs show that the probability of EuroFIT being cost-effective compared to no intervention is 0.53, 0.56 and 0.58 at thresholds of €10,000, €22,000 and €34,000 per QALY gained, respectively. When using a time horizon of 10 years, the results suggest that EuroFIT is more effective and less expensive compared to (i.e. dominant over) no intervention with a probability of cost-effectiveness of 0.63 at a threshold of €22,000 per QALY gained.ConclusionsWe conclude the EuroFIT intervention is not cost-effective compared to no intervention over a period of 5 years from a societal perspective, but is more effective and less expensive (i.e. dominant) after 10 years. We thus suggest that EuroFIT can potentially improve public health in a cost-effective manner in the long term.
Highlights
Physical activity decreases the risk of non-communicable diseases such as coronary heart disease, Type 2 diabetes, colorectal cancer, stroke and depression [1,2,3,4]
quality adjusted life years (QALYs) in the European Fans in Training (EuroFIT) group were 40,431 compared to 40,405 in the no intervention group, resulting in a small gain of 126 QALYs (+ 0.31%) in favour of EuroFIT, which is equivalent to 0.013 QALYs gained per participant
EuroFIT generates 195 QALYs more than no intervention based on time spent in the health states describing the physical activity levels
Summary
Physical activity decreases the risk of non-communicable diseases such as coronary heart disease, Type 2 diabetes, colorectal cancer, stroke and depression [1,2,3,4]. Some benefits from physical activity occur quickly, such as reduced blood pressure, and improved sleep, cognitive function and insulin sensitivity; others, such as increased cardiorespiratory fitness, decreased depressive symptoms, and sustained reduction in blood pressure, only accrue over months or years of increased physical activity [1]. Based on the results of a pragmatic randomised controlled trial (RCT), FFIT participants lost more weight over 12 months than control participants (mean difference in percentage weight loss 4.36% (95% confidence interval (CI) 3.64 to 5.08) [17]. Weight loss was sustained over 3.5 years of follow-up (mean percentage weight loss from baseline 2.36% (95% CI 1.41 to 3.31) [18]
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