Abstract
BackgroundExercise referral schemes (ERS) aim to identify inactive adults in the primary care setting. The primary care professional refers the patient to a third party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the patient. This paper examines the cost-effectiveness of ERS in promoting physical activity compared with usual care in primary care setting.MethodsA decision analytic model was developed to estimate the cost-effectiveness of ERS from a UK NHS perspective. The costs and outcomes of ERS were modelled over the patient's lifetime. Data were derived from a systematic review of the literature on the clinical and cost-effectiveness of ERS, and on parameter inputs in the modelling framework. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses investigated the impact of varying ERS cost and effectiveness assumptions. Sub-group analyses explored the cost-effectiveness of ERS in sedentary people with an underlying condition.ResultsCompared with usual care, the mean incremental lifetime cost per patient for ERS was £169 and the mean incremental QALY was 0.008, generating a base-case incremental cost-effectiveness ratio (ICER) for ERS at £20,876 per QALY in sedentary individuals without a diagnosed medical condition. There was a 51% probability that ERS was cost-effective at £20,000 per QALY and 88% probability that ERS was cost-effective at £30,000 per QALY. In sub-group analyses, cost per QALY for ERS in sedentary obese individuals was £14,618, and in sedentary hypertensives and sedentary individuals with depression the estimated cost per QALY was £12,834 and £8,414 respectively. Incremental lifetime costs and benefits associated with ERS were small, reflecting the preventative public health context of the intervention, with this resulting in estimates of cost-effectiveness that are sensitive to variations in the relative risk of becoming physically active and cost of ERS.ConclusionsERS is associated with modest increase in lifetime costs and benefits. The cost-effectiveness of ERS is highly sensitive to small changes in the effectiveness and cost of ERS and is subject to some significant uncertainty mainly due to limitations in the clinical effectiveness evidence base.
Highlights
Exercise referral schemes (ERS) aim to identify inactive adults in the primary care setting
In an ERS, people who are sedentary and/or have risk factor(s) for conditions known to benefit from physical activity are referred by a primary care professional to a third party service, which prescribes and monitors an exercise programme tailored to the individual needs of the patients [9]
The findings presented by NICE [8] showed ERS compared with controls led to an incremental cost per person of £25.10 and a lifetime quality-adjusted life-year (QALY) gain of 0.31 per person equating to an incremental cost per QALY of £81
Summary
Exercise referral schemes (ERS) aim to identify inactive adults in the primary care setting. Exercise referral schemes (ERS) have become one of the most common interventions used to promote physical activity in primary care [8,9]. In an ERS, people who are sedentary and/or have risk factor(s) for conditions known to benefit from physical activity (e.g. high blood pressure) are referred by a primary care professional to a third party service (often a sports centre or leisure facility), which prescribes and monitors an exercise programme tailored to the individual needs of the patients [9]. A systematic review identified four previous economic evaluations [10] These comprised three trial-based economic evaluations of ERS [11,12,13] and one model-based evaluation [8] of the cost-effectiveness of brief interventions in primary care to promote physical activity, including ERS. The evidence tends to focus on sedentary but otherwise healthy individuals, while a number of individuals are currently referred to an ERS with a diagnosed condition, such as coronary heart disease or depression [14]
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