Abstract
BackgroundGovernment interest in investing in commercial physical activity apps has increased with little evidence of their cost-effectiveness. This is the first study to our knowledge to examine the cost-effectiveness of a commercial physical activity app (Carrot Rewards) despite there being over 100,000 in the major app stores.MethodsA cost-effectiveness analysis was performed to calculate the incremental cost-effectiveness ratio (ICER) of the app compared to a no-intervention reference scenario using a five-year time horizon. Primary data was collected between 2016 and 2017. Data synthesis, model creation, and statistical analyses were conducted between 2019 and 2020. An age-, sex-, and geography-dependent Markov model was developed assuming a public healthcare payer perspective. A closed cohort (n = 38,452) representing the population reached by Carrot Rewards in two Canadian provinces (British Columbia, Newfoundland & Labrador) at the time of a 12-month prospective study was used. Costs and effects were both discounted at 1.5% and expressed in 2015 Canadian dollars. Subgroup analyses were conducted to compare ICERs between provinces, sexes, age groups, and engagement levels.ResultsCarrot Rewards had an ICER of $11,113 CAD per quality adjusted life year (QALY), well below a $50,000 CAD per QALY willingness-to-pay (WTP) threshold. Subgroup analyses revealed that the app had lower ICERs for British Columbians, females, highly engaged users, and adults aged 35-64 yrs., and was dominant for older adults (65 + yrs). Deterministic sensitivity analyses revealed that the ICER was most influenced by the relative risk of diabetes. Probabilistic sensitivity analyses revealed varying parameter estimates predominantly resulted in ICERs below the WTP threshold.ConclusionsThe Carrot Rewards app was cost-effective, and dominant for older adults. These results provide, for the first time, rigorous health economic evidence for a commercial physical activity app as part of public health programming.
Highlights
Government interest in investing in commercial physical activity apps has increased with little evidence of their cost-effectiveness
The World Health Organization (WHO) singled out digital innovation as an important component of a broad “systemsbased” solution in their Global Action Plan on Physical Activity [7]
We evaluate the cost-effectiveness of a commercial physical activity app, Carrot Rewards, which was found to increase objectively-measured daily step counts in a 12month prospective cohort study
Summary
Government interest in investing in commercial physical activity apps has increased with little evidence of their cost-effectiveness. The WHO singled out digital innovation (e.g., mobile health applications, or mHealth apps) as an important component of a broad “systemsbased” solution in their Global Action Plan on Physical Activity [7]. Despite their apparent potential, and growing interest amongst governments [8,9,10] and corporations, Rondina et al BMC Public Health (2021) 21:1950. We evaluate the cost-effectiveness of a commercial physical activity app, Carrot Rewards, which was found to increase objectively-measured daily step counts in a 12month prospective cohort study
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