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[null,null,"This Excel workbook contains the Evidence Map  on \nEconomic Evaluations of Exercise Therapy since 2015."]
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[null,null,"How this Evidence Map was generated"]
[null,null,"We searched heoro.com on the 10th January 2018 with the following field settings:"]
[null,null,"Intervention: Exercise therapy; Study type: Economic evaluations; Publication dates: 2015 to 2018"]
[null,null,"The search identified a total of 100 relevant abstracts published since 2015, which were  segmented with the following standard heoro.com fields:"]
[null,null,null,"Locations - the geographical setting of the study, or, where this is unknown, the authors' location."]
[null,null,null,"Disease - the disease for which exercise therapy is being used"]
[null,null,null,"Interventions - the interventions evaluated in the study, if any."]
[null,null,null,"Study type -  the type of economic model used in the evaluation"]
[null,null,null,"Study methodology - the type of study that was conducted, e.g. RCT, cohort, systematic review."]
[null,null,null,"Subpopulation - whether the study assessed adults, children, the elderly or any population"]
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[null,null,"In addition the following publication date segmentations are used:"]
[null,null,null,"1960 to 2014; 2015; 2016; 2017 to 2018"]
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[null,null,"All data in this Evidence Map is taken from the heoro.com database"]
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[null,null,"Details of the PubMed search strategy used to populate the heoro.com database can be found here."]
[]
[null,null,"Contact us:"]
[null,null,"Address: Crystallise Ltd. Unit 21, Thames Enterpise Centre, Thames Industrial Park, East Tilbury, Essex, UK RM18 8RH"]
[null,null,"Tel: +44 (0)1375 488020"]
[null,null,"Email: alison.martin@crystallise.com"]

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[{"$f":"COUNT(A2:A900)","v":100},"Full citation","DOI","Authors","Title","Abstract","Citation","Locations","Year","Diseases","Interventions","PROtools","Subpopulations","Study types","Study methodologies","LocationsTags","SubpopulationsTags","DiseaseTags","InterventionsTags","StudytypesTags","StudyMethodologyTags","PROtoolTags","DateBand","C1","C2","C3","C4","C5","C6","C7","C8","C9","C10"]
[1,"Aboagye,E.,et al. (2015). \"Cost-effectiveness of early interventions for non-specific low back pain: a randomized controlled study investigating medical yoga,exercise therapy and self-care advice.\" J Rehabil Med 47(2): 167-173.",null,"Aboagye,E.,et al.","Cost-effectiveness of early interventions for non-specific low back pain: a randomized controlled study investigating medical yoga,exercise therapy and self-care advice","OBJECTIVE: To evaluate the cost-effectiveness of medical yoga as an early intervention compared with evidence-based exercise therapy and self-care advice for non-specific low back pain. DESIGN: Randomized controlled trial with a cost-effectiveness analysis. SUBJECTS: A total of 159 participants randomized into the medical yoga group (n = 52),the exercise therapy group (n = 52) and the self-care advice group (n = 55). METHODS: The health outcome measure EQ-5D was applied to measure quality of life data combined with cost data collected from treatment groups from baseline to 12 months follow-up. Outcome measure was health-related quality of life (HRQL). Incremental cost per quality adjusted life year (QALY) was also calculated. Cost-effectiveness analysis was conducted primarily from the societal and employer perspectives. RESULTS: Medical yoga is cost-effective compared with self-care advice if an employer considers the significant improvement in the HRQL of an employee with low back pain justifies the additional cost of treatment (i.e. in this study EUR 150). From a societal perspective,medical yoga is a cost-effective treatment compared with exercise therapy and self-care advice if an additional QALY is worth EUR 11,500. Sensitivity analysis suggests that medical yoga is more cost-effective than its alternatives. CONCLUSION: Six weeks of uninterrupted medical yoga thera-py is a cost-effective early intervention for non-specific low back pain,when treatment recommendations are adhered to.","J Rehabil Med 47(Number): 167-173","Unclear",2015,"Musculoskeletal","Medical Yoga",null,"Unspecified","CUA","RCT"]
[2,"Adie,K.,et al. (2017). \"Does the use of Nintendo Wii Sports(TM) improve arm function? Trial of Wii(TM) in Stroke: a randomized controlled trial and economics analysis.\" Clin Rehabil 31(2): 173-185.",null,"Adie,K.,et al.","Does the use of Nintendo Wii Sports(TM) improve arm function? Trial of Wii(TM) in Stroke: a randomized controlled trial and economics analysis","OBJECTIVE: The Trial of Wii in Stroke investigated the efficacy of using the Nintendo Wii Sports (Wii(TM)) to improve affected arm function after stroke. DESIGN: Multicentre,pragmatic,parallel group,randomized controlled trial. SETTING: Home-based rehabilitation. SUBJECTS: A total of 240 participants aged 24-90 years with arm weakness following a stroke within the previous six months. INTERVENTION: Participants were randomly assigned to exercise daily for six weeks using the Wii(TM) or arm exercises at home. MAIN MEASURES: Primary outcome was change in the affected arm function at six weeks follow-up using the Action Research Arm Test. Secondary outcomes included occupational performance,quality of life,arm function at six months and a cost effectiveness analysis. RESULTS: The study was completed by 209 participants (87.1%). There was no significant difference in the primary outcome of affected arm function at six weeks follow-up (mean difference -1.7,95% CI -3.9 to 0.5,p = 0.12) and no significant difference in secondary outcomes,including occupational performance,quality of life or arm function at six months,between the two groups. No serious adverse events related to the study treatment were reported. The cost effectiveness analysis showed that the Wii(TM) was more expensive than arm exercises pound1106 (SD 1656) vs. pound730 (SD 829) (probability 0.866). CONCLUSION: The trial showed that the Wii(TM) was not superior to arm exercises in home-based rehabilitation for stroke survivors with arm weakness. The Wii(TM) was well tolerated but more expensive than arm exercises.","Clin Rehabil 31(Number): 173-185","UK",2017,"Various","Home Based Training",null,"Adults,Elderly","CEA","RCT"]
[3,"Akanni,O. O.,et al. (2017). \"Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select.\" Int J Environ Res Public Health 14(5): 10.3390/ijerph14050545",null,"Akanni,O. O.,et al.","Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select","The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select,a community-based health promotion program previously shown to improve functional health,physical activity,nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach,personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained,as well as health outcomes,such as healthy days,weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days,physical activity and nutrition-related outcomes among participants,this study supports the use of Texercise Select as an intervention with substantial health and cost benefits.","Int J Environ Res Public Health 14(Number): ","USA",2017,"None","Texercise Select",null,"Elderly","CUA","Cohort"]
[4,"Andronis,L.,et al. (2017). \"Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review.\" Appl Health Econ Health Policy 15(2): 173-201.",null,"Andronis,L.,et al.","Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review","BACKGROUND: Low back pain (LBP) is a major health problem,having a substantial effect on peoples' quality of life and placing a significant economic burden on healthcare systems and,more broadly,societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear. OBJECTIVES: To identify,document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP. METHODS: Relevant studies were identified through systematic searches in bibliographic databases (EMBASE,MEDLINE,PsycINFO,Cochrane Library,CINAHL and the National Health Service Economic Evaluation Database),'similar article' searches and reference list scanning. Study selection was carried out by three assessors,independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms. RESULTS: Thirty-three studies were identified. Study interventions were categorised as: (1) combined physical exercise and psychological therapy,(2) physical exercise therapy only,(3) information and education,and (4) manual therapy. Interventions assessed within each category varied in terms of their components and delivery. In general,combined physical and psychological treatments,information and education interventions,and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole,with yoga,but not group exercise,being cost effective. CONCLUSIONS: The identified evidence suggests that combined physical and psychological treatments,medical yoga,information and education programmes,spinal manipulation and acupuncture are likely to be cost-effective options for LBP.","Appl Health Econ Health Policy 15(Number): 173-201","International",2017,"Musculoskeletal","Unspecified",null,"Unspecified","CEA","SLR"]
[5,"Barrett,J. L.,et al. (2015). \"Cost Effectiveness of an Elementary School Active Physical Education Policy.\" Am J Prev Med 49(1): 148-159.",null,"Barrett,J. L.,et al.","Cost Effectiveness of an Elementary School Active Physical Education Policy","INTRODUCTION: Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA,less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state \"active PE\" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA. METHODS: A cohort model was used to simulate the impact of an active PE policy on physical activity,BMI,and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014. RESULTS: An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23,2.51) and cost $70.7 million (95% UI=$51.1,$95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15,$2.15),and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148,$3,100). From 2015 to 2025,the policy would cost $235 million (95% UI=$170 million,$319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million,$153 million). CONCLUSIONS: Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.","Am J Prev Med 49(Number): 148-159","USA",2015,"None","Unspecified",null,"Adolescents","CEA","Cohort"]
[6,"Benmarhnia,T.,et al. (2017). \"Investing in a healthy lifestyle strategy: is it worth it?\" Int J Public Health 62(1): 3-13.",null,"Benmarhnia,T.,et al.","Investing in a healthy lifestyle strategy: is it worth it?","OBJECTIVES: In Quebec,various actors fund activities aimed at increasing physical activity,improving eating habits and reducing smoking. The objective was to evaluate how effective does the healthy lifestyle habits promotion (HLHP) strategy need to be to make to offset its costs. METHODS: First,we built the logic model of the HLHP strategy. We then assessed the strategy's total cost as well as the direct health care expenditures associated with lifestyle-related risk factors (smoking,physical inactivity,insufficient intake of fruits and vegetables,obesity and overweight). Finally,we estimated the break-even point beyond which the economic benefits of the HLHP strategy would outweigh its costs. RESULTS: The HLHP strategy cost for 2010-2011 was estimated at $110 million. Direct healthcare expenditures associated with lifestyle-related risk factors were estimated at $4.161 billion. We estimated that 47 % of these expenditures were attributable to these risk factors. CONCLUSIONS: We concluded that the HLHP strategy cost corresponded to 5.6 % of the annual healthcare expenditures attributable to these risk factors. This study compared the economic value of HLHP activities against healthcare expenditures associated with targeted risk factors.","Int J Public Health 62(Number): 3-13","Canada",2017,"None","Unspecified",null,"Unspecified","CBA","Cohort"]
[7,"Bennell,K. L.,et al. (2016). \"Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial.\" Arthritis Care Res (Hoboken) 68(5): 590-602.",null,"Bennell,K. L.,et al.","Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial","OBJECTIVE: To investigate whether a 12-week physical therapist-delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA). METHODS: This was an assessor-blinded,3-arm randomized controlled trial in 222 people (73 PCST/exercise,75 exercise,and 74 PCST) ages >/=50 years with knee OA. All participants received 10 treatments over 12 weeks plus a home program. PCST covered pain education and training in cognitive and behavioral pain coping skills,exercise comprised strengthening exercises,and PCST/exercise integrated both. Primary outcomes were self-reported average knee pain (visual analog scale,range 0-100 mm) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index,range 0-68) at week 12. Secondary outcomes included other pain measures,global change,physical performance,psychological health,physical activity,quality of life,and cost effectiveness. Analyses were by intent-to-treat methodology with multiple imputation for missing data. RESULTS: A total of 201 participants (91%),181 participants (82%),and 186 participants (84%) completed week 12,32,and 52 measurements,respectively. At week 12,there were no significant between-group differences for reductions in pain comparing PCST/exercise versus exercise (mean difference 5.8 mm [95% confidence interval (95% CI) -1.4,13.0]) and PCST/exercise versus PCST (6.7 mm [95% CI -0.6,14.1]). Significantly greater improvements in function were found for PCST/exercise versus exercise (3.7 units [95% CI 0.4,7.0]) and PCST/exercise versus PCST (7.9 units [95% CI 4.7,11.2]). These differences persisted at weeks 32 (both) and 52 (PCST). Benefits favoring PCST/exercise were seen on several secondary outcomes. Cost effectiveness of PCST/exercise was not demonstrated. CONCLUSION: This model of care could improve access to psychological treatment and augment patient outcomes from exercise in knee OA,although it did not appear to be cost effective.","Arthritis Care Res (Hoboken) 68(Number): 590-602","UK,Australia,Canada",2016,"Musculoskeletal","PCST",null,"Elderly","CEA","RCT"]
[8,"Blanchette,M. A.,et al. (2016). \"Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies.\" PLoS One 11(8): e0160037.",null,"Blanchette,M. A.,et al.","Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies","BACKGROUND CONTEXT: Low back pain (LBP) is one of the leading causes of disability worldwide and among the most common reasons for seeking primary sector care. Chiropractors,physical therapists and general practitioners are among those providers that treat LBP patients,but there is only limited evidence regarding the effectiveness and economic evaluation of care offered by these provider groups. PURPOSE: To estimate the clinical effectiveness and to systematically review the literature of full economic evaluation of chiropractic care compared to other commonly used care approaches among adult patients with non-specific LBP. STUDY DESIGN: Systematic reviews of interventions and economic evaluations. METHODS: A comprehensive search strategy was conducted to identify 1) pragmatic randomized controlled trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared to standard care delivered by other healthcare providers. Studies published between 1990 and 4th June 2015 were considered. Primary outcomes included pain,functional status and global improvement. Study selection,critical quality appraisal and data extraction were conducted by two independent reviewers. Data from RCTs with low risk of bias were included in a meta-analysis to determine effect estimates. Cost estimates of full economic evaluations were converted to 2015 USD and results summarized using Slavin's qualitative best-evidence synthesis. RESULTS: Six RCTs and three full economic evaluations were scientifically admissible. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1),physical therapy (n = 3) and medical care (n = 1). Overall,we found similar effects for chiropractic care and the other types of care and no reports of serious adverse events. Three low to high quality full economic evaluations studies (one cost-effectiveness,one cost-minimization and one cost-benefit) compared chiropractic to medical care. Given the divergent conclusions (favours chiropractic,favours medical care,equivalent options),mixed-evidence was found for economic evaluations of chiropractic care compared to medical care. CONCLUSION: Moderate evidence suggests that chiropractic care for LBP appears to be equally effective as physical therapy. Limited evidence suggests the same conclusion when chiropractic care is compared to exercise therapy and medical care although no firm conclusion can be reached at this time. No serious adverse events were reported for any type of care. Our review was also unable to clarify whether chiropractic or medical care is more cost-effective. Given the limited available evidence,the decision to seek or to refer patients for chiropractic care should be based on patient preference and values. Future studies are likely to have an important impact on our estimates as these were based on only a few admissible studies.","PLoS One 11(Number): e0160037","International",2016,"Musculoskeletal","Unspecified",null,"Unspecified","CEA,CBA,CMA","SLR"]
[9,"Brodin,N.,et al. (2015). \"Cost-effectiveness of a one-year coaching program for healthy physical activity in early rheumatoid arthritis.\" Disabil Rehabil 37(9): 757-762.",null,"Brodin,N.,et al.","Cost-effectiveness of a one-year coaching program for healthy physical activity in early rheumatoid arthritis","PURPOSE: To describe cost-effectiveness of the Physical Activity in Rheumatoid Arthritis (PARA) study intervention. METHOD: Costs were collected and estimated retrospectively. Cost-effectiveness was calculated based on the intervention cost per patient with respect to change in health status (EuroQol global visual analog scale--EQ-VAS and EuroQol--EQ-5D) and activity limitation (Health assessment questionnaire - HAQ) using cost-effectiveness- and cost-minimization analyses. RESULTS: Total cost of the one-year intervention program was estimated to be euro67 317 or euro716 per participant. Estimated difference in total societal cost between the intervention (IG) and control (CG) was euro580 per participant. Incremental cost-effectiveness ratio (ICER) for one point (1/100) of improvement in EQ-VAS was estimated to be euro116. By offering the intervention to more affected participants in the IG compared to less affected participants,15.5 extra points of improvement in EQ-VAS and 0.13 points of improvement on HAQ were gained at the same cost. \"Ordinary physiotherapy\" was most cost-effective with regard to EQ-5D. CONCLUSIONS: The intervention resulted in improved effect in health status for the IG with a cost of euro116 per extra point in VAS. The intervention was cost-effective if targeted towards a subgroup of more affected patients when evaluating the effect using VAS and HAQ. IMPLICATIONS FOR REHABILITATION: The physical activity coaching intervention resulted in an improved effect on VAS for the intervention group,to a higher cost. In order to maximize cost-effectiveness,this type of physical activity coaching intervention should be targeted towards patients largely affected by their RA. The intervention is cost-effective from the patients' point of view,but not from that of the general population.","Disabil Rehabil 37(Number): 757-762","Unclear",2015,"Musculoskeletal","Unspecified",null,"Unspecified","CUA,CMA","Cohort"]
[10,"Brown,V.,et al. (2017). \"Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study.\" BMC Public Health 17(1): 359.",null,"Brown,V.,et al.","Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study","BACKGROUND: Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments,thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. METHODS: A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity,injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis. RESULTS: Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity,whilst nine studies reported associations specifically with physical activity,walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary,with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained,AUD2.6 M in healthcare cost savings),measured against a comparator of no additional increase in fuel excise. Under \"best case\" assumptions,the intervention would be more cost-effective (3181 HALYs gained,AUD34.2 M in healthcare cost savings). CONCLUSIONS: Exploratory analysis suggests that an intervention to increase fuel excise taxation may deliver obesity and physical activity related benefits. Whilst such an intervention has significant potential for cost-effectiveness,potential equity and acceptability impacts would need to be minimised. A better understanding of the effectiveness and cost-effectiveness of a range of transport interventions is required in order to achieve more physically active transport environments.","BMC Public Health 17(Number): 359","Australia",2017,"Various","Unspecified","HALY","Any","CEA","SLR"]
[11,"Burn,E.,et al. (2015). \"The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: a Markov model informed by a randomised controlled trial.\" BMJ Open 5(4): e007226.",null,"Burn,E.,et al.","The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: a Markov model informed by a randomised controlled trial","OBJECTIVES: To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active,primarily through the use of personalised SMS text-messages. DESIGN: A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. SETTING: This study considers the cost-effectiveness of MobileMums in Queensland,Australia. PARTICIPANTS: A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland,Australia. DATA SOURCES: The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort,treatment effects and resource utilisation were all informed by this trial. MAIN OUTCOME MEASURES: The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. RESULTS: The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. CONCLUSIONS: At a cost-effectiveness threshold of 64 000 AUD,MobileMums would likely be a cost-effective use of healthcare resources in Queensland,Australia. TRIAL REGISTRATION NUMBER: Australian Clinical Trials Registry; ACTRN12611000481976.","BMJ Open 5(Number): e007226","Australia",2015,"None","Unspecified",null,"Adults","CUA","RCT"]
[12,"Campbell,F.,et al. (2015). \"A systematic review and economic evaluation of exercise referral schemes in primary care: a short report.\" Health Technol Assess 19(60): 1-110.",null,"Campbell,F.,et al.","A systematic review and economic evaluation of exercise referral schemes in primary care: a short report","BACKGROUND: It is estimated that only 39% of men and 29% of women in England achieve the levels of physical activity that are recommended to protect health and prevent disease. One approach to addressing this problem has been the development of exercise referral schemes (ERSs),in which health professionals refer patients to external exercise providers. These schemes have been widely rolled out across the UK despite concerns that they may not produce sustained changes in levels of physical activity and,therefore,may not be cost-effective interventions. The evidence to determine clinical effectiveness and cost-effectiveness was evaluated in 2009. This review seeks to update this earlier work by incorporating new evidence and re-examining the cost-effectiveness. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of ERSs compared with usual care. DESIGN: Exhaustive searches of relevant electronic databases and journals were undertaken to identify new studies evaluating ERSs using a randomised controlled trial (RCT) design. RCTs that incorporated a qualitative evaluation of the intervention were identified in order to explore the barriers and facilitators to the uptake of and adherence to ERSs. Data were extracted using a previously designed tool and study quality assessed for potential bias. Where data could be pooled,meta-analyses were carried out. Qualitative analysis was also undertaken using a thematic approach. The cost-effectiveness was evaluated using a Markov structure which estimated the likelihood of becoming physically active and the subsequent risk reduction on coronary heart disease (CHD),stroke and type 2 diabetes mellitus. The model adopts a lifetime horizon,and a NHS and Personal Social Services perspective was taken with discounting at 1.5% for both costs and benefits. RESULTS: The search identified one new RCT and one new qualitative study. The new data were pooled with existing data from the 2011 review by Pavey et al. [Pavey TG,Anokye N,Taylor AH,Trueman P,Moxham T,Fox KR,et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess 2011;15(44)] to give a total of eight studies with 5190 participants. The proportion of individuals achieving 90-150 minutes of at least moderate-intensity activity per week at 6-12 months' follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). Older patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. Exercise referral gained 0.003 quality-adjusted life-years (QALYs) at an additional cost of pound225 per person. The estimated mean incremental cost-effectiveness ratio (ICER) in the probabilistic sensitivity analysis was pound76,276. In the univariate sensitivity analysis the results were very sensitive (ICERs ranged from < pound30,000 to > pound100,000) to changes in the effect of ERSs on physical activity uptake and the duration of the protective effects and the direct health-related quality-of-life gains attributable to physical activity. CONCLUSIONS: Exercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. The cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around pound76,000 per QALY,although the cost-effectiveness of ERSs is subject to considerable uncertainty. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005200. FUNDING: National Institute for Health Research Health Technology Assessment programme.","Health Technol Assess 19(Number): 1-110","UK",2015,"Various","Unspecified",null,"Adults","CUA","SLR"]
[13,"Carande-Kulis,V.,et al. (2015). \"A cost-benefit analysis of three older adult fall prevention interventions.\" J Safety Res 52: 65-70.",null,"Carande-Kulis,V.,et al.","A cost-benefit analysis of three older adult fall prevention interventions","INTRODUCTION: One out of three persons aged 65 and older falls annually and 20% to 30% of falls result in injury. The purpose of this cost-benefit analysis was to identify community-based fall interventions that were feasible,effective,and provided a positive return on investment (ROI). METHODS: A third-party payer perspective was used to determine the costs and benefits of three effective fall interventions. Intervention effectiveness was based on randomized controlled trial results. National data were used to estimate the average annual benefits from averting the direct medical costs of a fall. The net benefit and ROI were estimated for each of the interventions. RESULTS: For the Otago Exercise Program delivered to persons aged 65 and older,the net benefit was $121.85 per participant and the ROI was 36% for each dollar invested. For Otago delivered to persons aged 80 and older,the net benefit was $429.18 and the ROI was 127%. Tai chi: Moving for Better Balance had a net benefit of $529.86 and an ROI of 509% and Stepping On had a net benefit of $134.37 and an ROI of 64%. CONCLUSIONS: All three fall interventions provided positive net benefits. The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs. These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment.","J Safety Res 52(Number): 65-70","USA",2015,"Various","Unspecified",null,"Elderly","CBA","RCT"]
[14,"Cheng,Q.,et al. (2016). \"Cost-effectiveness of a Population-based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Non-attenders of Cardiac Rehabilitation.\" Heart Lung Circ 25(3): 265-274.",null,"Cheng,Q.,et al.","Cost-effectiveness of a Population-based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Non-attenders of Cardiac Rehabilitation","BACKGROUND: To evaluate the long-term cost-effectiveness of two home-based cardiac rehabilitation (CR) interventions (Healthy Weight (HW) and Physical Activity (PA)) for patients with cardiovascular disease (CVD),who had been referred to cardiac rehabilitation (CR) but had not attended. The interventions consisted of pedometer-based telephone coaching sessions on weight,nutrition and physical activity (HW group) or physical activity only (PA group) and were compared to a control group who received information brochures about physical activity. METHODS: A cost-effectiveness analysis was conducted using data from two randomised controlled trials. One trial compared HW to PA (PANACHE study),and the second compared PA to usual care. A Markov model was developed which used one risk factor,body mass index (BMI) to determine the CVD risk level and mortality. Patient-level data from the trials were used to determine the transitions to CVD states and healthcare related costs. The model was run for separate cohorts of males and females. Univariate and probabilistic sensitivity analysis were conducted to test the robustness of the results. RESULTS: Given a willingness-to-pay threshold of $50,000/QALY,in the long run,both the HW and PA interventions are cost-effective compared with usual care. While the HW intervention is more effective,it also costs more than both the PA intervention and the control group due to higher intervention costs. However,the HW intervention is still cost-effective relative to the PA intervention for both men and women. Sensitivity analysis suggests that the results are robust. CONCLUSION: The results of this paper provide evidence of the long-term cost-effectiveness of home-based CR interventions for patients who are referred to CR but do not attend. Both the HW and PA interventions can be recommended as cost-effective home-based CR programs,especially for people lacking access to hospital services or who are unable to participate in traditional CR programs.","Heart Lung Circ 25(Number): 265-274","UK,Australia",2016,"Cardiovascular","Unspecified",null,"Unspecified","CUA","RCT"]
[15,"Clarkson,P.,et al. (2017). \"A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia.\" Value Health 20(8): 1198-1209.",null,"Clarkson,P.,et al.","A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia","BACKGROUND: Recent evidence signals the need for effective forms of home support to people with dementia and their carers. The cost-effectiveness evidence of different approaches to support is scant. OBJECTIVES: To appraise economic evidence on the cost-effectiveness of home support interventions for dementia to inform future evaluation. METHODS: A systematic literature review of full and partial economic evaluations was performed using the British National Health Service Economic Evaluation Database supplemented by additional references. Study characteristics and findings,including incremental cost-effectiveness ratios,when available,were summarized narratively. Study quality was appraised using the National Health Service Economic Evaluation Database critical appraisal criteria and independent ratings,agreed by two reviewers. Studies were located on a permutation matrix describing their mix of incremental costs/effects to aid decision making. RESULTS: Of the 151 articles retrieved,14 studies met the inclusion criteria: 8 concerning support to people with dementia and 6 to carers. Five studies were incremental cost-utility analyses,seven were cost-effectiveness analyses,and two were cost consequences analyses. Five studies expressed incremental cost-effectiveness ratios as cost per quality-adjusted life-year ( pound6,696- pound207,942 per quality-adjusted life-year). In four studies,interventions were dominant over usual care. Two interventions were more costly but more beneficial and were favorable against current acceptability thresholds. CONCLUSIONS: Occupational therapy,home-based exercise,and a carers' coping intervention emerged as cost-effective approaches for which there was better evidence. These interventions used environmental modifications,behavior management,physical activity,and emotional support as active components. More robust evidence is needed to judge the value of these and other interventions across the dementia care pathway.","Value Health 20(Number): 1198-1209","International",2017,"Dementia","Multiple",null,"Elderly","CUA,CEA,CCA","SLR"]
[16,"Cockayne,S.,et al. (2017). \"Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial).\" Health Technol Assess 21(24): 1-198.",null,"Cockayne,S.,et al.","Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial)","BACKGROUND: Falls are a serious cause of morbidity and cost to individuals and society. Evidence suggests that foot problems and inappropriate footwear may increase the risk of falling. Podiatric interventions could help reduce falls; however,there is limited evidence regarding their clinical effectiveness and cost-effectiveness. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for preventing falls in community-dwelling older people at risk of falling,relative to usual care. DESIGN: A pragmatic,multicentred,cohort randomised controlled trial with an economic evaluation and qualitative study. SETTING: Nine NHS trusts in the UK and one site in Ireland. PARTICIPANTS: In total,1010 participants aged >/= 65 years were randomised (intervention,n = 493; usual care,n = 517) via a secure,remote service. Blinding was not possible. INTERVENTIONS: All participants received a falls prevention leaflet and routine care from their podiatrist and general practitioner. The intervention also consisted of footwear advice,footwear provision if required,foot orthoses and foot- and ankle-strengthening exercises. MAIN OUTCOME MEASURES: The primary outcome was the incidence rate of falls per participant in the 12 months following randomisation. The secondary outcomes included the proportion of fallers and multiple fallers,time to first fall,fear of falling,fracture rate,health-related quality of life (HRQoL) and cost-effectiveness. RESULTS: The primary analysis consisted of 484 (98.2%) intervention and 507 (98.1%) usual-care participants. There was a non-statistically significant reduction in the incidence rate of falls in the intervention group [adjusted incidence rate ratio 0.88,95% confidence interval (CI) 0.73 to 1.05; p = 0.16]. The proportion of participants experiencing a fall was lower (50% vs. 55%,adjusted odds ratio 0.78,95% CI 0.60 to 1.00; p = 0.05). No differences were observed in key secondary outcomes. No serious,unexpected and related adverse events were reported. The intervention costs pound252.17 more per participant (95% CI - pound69.48 to pound589.38) than usual care,was marginally more beneficial in terms of HRQoL measured via the EuroQoL-5 Dimensions [mean quality-adjusted life-year (QALY) difference 0.0129,95% CI -0.0050 to 0.0314 QALYs] and had a 65% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of pound30,000 per QALY gained. The intervention was generally acceptable to podiatrists and trial participants. LIMITATIONS: Owing to the difficulty in calculating a sample size for a count outcome,the sample size was based on detecting a difference in the proportion of participants experiencing at least one fall,and not the primary outcome. We are therefore unable to confirm if the trial was sufficiently powered for the primary outcome. The findings are not generalisable to patients who are not receiving podiatry care. CONCLUSIONS: The intervention was safe and potentially effective. Although the primary outcome measure did not reach significance,a lower fall rate was observed in the intervention group. The reduction in the proportion of older adults who experienced a fall was of borderline statistical significance. The economic evaluation suggests that the intervention could be cost-effective. FUTURE WORK: Further research could examine whether or not the intervention could be delivered in group sessions,by physiotherapists,or in high-risk patients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN68240461. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21,No. 24. See the NIHR Journals Library website for further project information.","Health Technol Assess 21(Number): 1-198","UK",2017,"Various","Unspecified",null,"Elderly","CUA","RCT"]
[17,"Cohen,D.,et al. (2016). \"CicLAvia: Evaluation of participation,physical activity and cost of an open streets event in Los Angeles.\" Prev Med 90: 26-33.",null,"Cohen,D.,et al.","CicLAvia: Evaluation of participation,physical activity and cost of an open streets event in Los Angeles","Physical activity is beneficial for health,but there are limited opportunities in urban areas to safely access public streets for traffic-free cycling,skating or walking. Ciclovias are open streets programs that close major roads to motor vehicles so they can be exclusively used by bicyclists and pedestrians. We estimated participation in one Los Angeles Ciclovia event (CicLAvia) using intercept surveys and 14 surveillance cameras which were placed along the 6-mile route in April 2014. We also applied estimates of the distance and speed traveled from the use of GPS data acquired from subsequent CicLAvia events. CicLAvia attracted between 37,700 and 53,950 active participants generating 176,500 to 263,000 MET-hours of energy expenditure,at an estimated cost borne by tax dollars of $1.29 to $1.91 per MET-hour. Among participants,37% had never previously participated in CicLAvia,but 40% of individuals said that if they were not at CicLAvia they would have been physically active elsewhere and 45% would have been sedentary. Given its large reach,it makes sense to increase the frequency of Ciclovias to occur more than a few times a year to promote population health.","Prev Med 90(Number): 26-33","USA",2016,"None","Cycling,Walking",null,"Any","CEA","Cohort"]
[18,"Cowper,P. A.,et al. (2017). \"Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial.\" J Am Geriatr Soc 65(3): 533-539.",null,"Cowper,P. A.,et al.","Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial","OBJECTIVES: To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans. DESIGN: Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance,physical activity,function,disability,and medical resource use and cost. SETTING: Veterans Affairs Medical Center,Durham,North Carolina. PARTICIPANTS: Male veterans aged >/=70 years (n = 398). INTERVENTION: An experienced health counselor provided baseline in-person exercise counseling,followed by telephone counseling at 2,4,and 6 weeks,and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention,followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly. MEASUREMENTS: Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated. RESULTS: The total direct cost of the intervention per participant was $459,85% of which was counselor effort. With overhead,program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention,versus $12,052 with usual care (difference = -$1,634 (95% confidence interval = -$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes,the intervention cost $4,971 per additional patient reaching target exercise levels,or $4,640 per patient achieving a clinically significant change in rapid gait speed. CONCLUSION: Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.","J Am Geriatr Soc 65(Number): 533-539","USA",2017,"None","Unspecified",null,"Elderly","CEA","RCT"]
[19,"Cradock,A. L.,et al. (2017). \"Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood.\" Prev Med 95 Suppl: S17-s27.",null,"Cradock,A. L.,et al.","Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood","Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives,we simulate the national implementation,impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school,afterschool and childcare settings. In 2016,the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day,intervention reach and cost per person,cost per MET-hour change,ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity,including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.","Prev Med 95 Suppl(Number): S17-s27","USA",2017,"None","Unspecified",null,"Children","CEA","SLR"]
[20,"D'Amico,F.,et al. (2016). \"Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial.\" Int J Geriatr Psychiatry 31(6): 656-665.",null,"D'Amico,F.,et al.","Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial","OBJECTIVE: Although available evidence is modest,exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. We aim to evaluate the cost-effectiveness of a dyadic exercise regimen for individuals with dementia and their main carer as therapy for behavioural and psychological symptoms of dementia. METHODS: Cost-effectiveness analysis within a two-arm,pragmatic,randomised,controlled,single-blind,parallel-group trial of a dyadic exercise regimen (individually tailored,for 20-30 min at least five times per week). The study randomised 131 community-dwelling individuals with dementia and clinically significant behavioural and psychological symptoms with a carer willing and able to participate in the exercise regimen; 52 dyads provided sufficient cost data for analyses. RESULTS: Mean intervention cost was pound284 per dyad. For the subsample of 52 dyads,the intervention group had significantly higher mean cost from a societal perspective (mean difference pound2728.60,p = 0.05),but costs were not significantly different from a health and social care perspective. The exercise intervention was more cost-effective than treatment as usual from both societal and health and social care perspectives for the measure of behavioural and psychological symptoms (Neuropsychiatric Inventory). It does not appear cost-effective in terms of cost per quality-adjusted life year gain. CONCLUSIONS: The exercise intervention has the potential to be seen as cost-effective when considering behavioural and psychological symptoms but did not appear cost-effective when considering quality-adjusted life year gains.","Int J Geriatr Psychiatry 31(Number): 656-665","UK",2016,"Dementia","Multiple",null,"Elderly","CUA,CEA","RCT"]
[21,"Dang,W.,et al. (2017). \"Cost-Effectiveness of Multidisciplinary Management Program and Exercise Training Program in Heart Failure.\" Am J Cardiol 120(8): 1338-1343.",null,"Dang,W.,et al.","Cost-Effectiveness of Multidisciplinary Management Program and Exercise Training Program in Heart Failure","Heart failure causes significant health and financial burdens for patients and society. Multidisciplinary management program (MMP) and exercise training program (ETP) have been reported as cost-effective in improving health outcomes,yet no study has compared the 2 programs. We constructed a Markov model to simulate life year (LY) gained and total costs in usual care (UC),MMP,and ETP. The probability of transitions between states and healthcare costs were extracted from previous literature. We calculated the incremental cost-effectiveness ratio (ICER) over a 10-year horizon. Model robustness was assessed through 1-way and probabilistic sensitivity analyses. The expected LY for patients treated with UC,MMP,and ETP was 7.6,8.2,and 8.4 years,respectively. From a societal perspective,the expected cost of MMP was $20,695,slightly higher than the cost of UC ($20,092). The cost of ETP was much higher ($48,378) because of its high implementation expense and the wage loss it incurred. The ICER of MMP versus UC was $976 per LY gained,and the ICER of ETP versus MMP was $165,702 per LY gained. The results indicated that,under current cost-effectiveness threshold,MMP is cost-effective compared with UC,and ETP is not cost-effective compared with MMP. However,ETP is cost-effective compared with MMP from a healthcare payer's perspective.","Am J Cardiol 120(Number): 1338-1343","USA",2017,"Cardiovascular","Unspecified",null,"Any","CEA","SLR"]
[22,"Davis,J. C.,et al. (2015). \"Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia.\" Br J Sports Med 49(20): 1343-1347.",null,"Davis,J. C.,et al.","Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia","BACKGROUND: Cognitive decline is one of the most prominent healthcare issues of the 21st century. Within the context of combating cognitive decline through behavioural interventions,physical activity is a promising approach. There is a dearth of health economic data in the area of behavioural interventions for dementia prevention. Yet,economic evaluations are essential for providing information to policy makers for resource allocation. It is essential we first address population and intervention-specific methodological challenges prior to building a larger evidence base. We use a cost-utility analysis conducted alongside the exercise for cognition and everyday living (EXCEL) study to illustrate methodological challenges specific to assessing the cost-effectiveness of behavioural interventions aimed at older adults at risk of cognitive decline. METHODS: A cost-utility analysis conducted concurrently with a 6-month,three-arm randomised controlled trial (ie,the EXCEL study) was used as an example to identify and discuss methodological challenges. RESULTS: Both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. In critically evaluating the economic evaluation of the EXCEL study we identified four category-specific challenges: (1) analysing costs; (2) assessing quality-adjusted life-years; (3) Incomplete data; and (4) 'Intervention' activities of the control group. CONCLUSIONS: Resistance training and aerobic training resulted in healthcare cost saving and were equally effective to balance and tone classes after only 6 months of intervention. To ensure this population is treated fairly in terms of claims on resources,we first need to identify areas for methodological improvement.","Br J Sports Med 49(Number): 1343-1347","Canada",2015,"Dementia","Multiple",null,"Elderly","CUA","RCT"]
[23,"Davis,J. C.,et al. (2017). \"Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial.\" BMJ Open 7(3): e014387.",null,"Davis,J. C.,et al.","Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial","BACKGROUND/OBJECTIVES: Evidence suggests that aerobic exercise may slow the progression of subcortical ischaemic vascular cognitive impairment (SIVCI) by modifying cardiovascular risk factors. Yet the economic consequences relating to aerobic training (AT) remain unknown. Therefore,our primary objective was to estimate the incremental cost per quality-adjusted life years (QALYs) gained of a thrice weekly AT intervention compared with usual care. DESIGN: Cost-utility analysis alongside a randomised trial. SETTING: Vancouver,British Columbia,Canada. PARTICIPANTS: 70 adults (mean age of 74 years,51% women) who meet the diagnostic criteria for mild SIVCI. INTERVENTION: A 6-month,thrice weekly,progressive aerobic exercise training programme compared with usual care (CON; comparator) with a follow-up assessment 6 months after formal cessation of aerobic exercise training. MEASUREMENTS: Healthcare resource usage was estimated over the 6-month intervention and 6-month follow-up period. Health status (using the EQ-5D-3L) at baseline and trial completion and 6-month follow-up was used to calculate QALYs. The incremental cost-utility ratio (cost per QALY gained) was calculated. RESULTS: QALYs were both modestly greater,indicating a health gain. Total healthcare costs (ie,1791+/-1369 {2015 $CAD} at 6 months) were greater,indicating a greater cost for the thrice weekly AT group compared with CON. From the Canadian healthcare system perspective,the incremental cost-utility ratios for thrice weekly AT were cost-effective compared with CON,when using a willingness to pay threshold of $CAD 20 000 per QALY gained or higher. CONCLUSIONS: AT represents an attractive and potentially cost-effective strategy for older adults with mild SIVCI. TRIAL REGISTRATION NUMBER: NCT01027858.","BMJ Open 7(Number): e014387","Canada",2017,"Dementia","Aerobic Training",null,"Elderly","CUA","RCT"]
[24,"Farag,I.,et al. (2015). \"Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization.\" J Am Med Dir Assoc 16(6): 490-496.",null,"Farag,I.,et al.","Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization","BACKGROUND: Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. OBJECTIVE: To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. METHOD: An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60 years and older,with a recent hospital admission,were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery),per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. RESULTS: The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility,$A19,020 per extra person indicating an improvement in health,and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes. CONCLUSION: The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup.","J Am Med Dir Assoc 16(Number): 490-496","Australia",2015,"Unspecified","Unspecified",null,"Elderly","CEA,CUA","RCT"]
[25,"Farag,I.,et al. (2016). \"Economic evaluation of a falls prevention exercise program among people With Parkinson's disease.\" Mov Disord 31(1): 53-61.",null,"Farag,I.,et al.","Economic evaluation of a falls prevention exercise program among people With Parkinson's disease","OBJECTIVE: The aim of this study was to determine the cost-effectiveness of a 6-month minimally supervised exercise program for people with PD. METHODS: An economic analysis was conducted alongside a randomized,controlled trial in which 231 people age 40 years and over with PD were randomized into a usual care control group or an exercise group. Cost-effectiveness was estimated using incremental cost per fall prevented (using falls calendars) as the primary analysis and cost per extra person avoiding mobility deterioration (defined as an improvement or no change in the 12-point Short Physical Performance Battery Score between baseline and 6 month). A cost-utility analysis using the Short Form-6D was also performed. Uncertainty was represented using cost-effectiveness scatter plots and acceptability curves. Planned subgroup analyses for the low-disease-severity group were also undertaken. RESULTS: All results are reported in Australian dollars ($A). The average cost of the intervention was $A1,010 per participant. Incremental cost-effectiveness of the program relative to usual care was $A574 per fall prevented,$A9,570 per extra person avoiding mobility deterioration,and $A338,800 per quality-adjusted life year gained. The intervention had an 80% probability of being cost-effective,relative to the control,at a threshold of $A2,000 per fall prevented. Subgroup analyses for the low-disease-severity group indicate the program to be dominant,that is,less costly and more effective than usual care for all health outcomes. CONCLUSION: The exercise intervention appeared cost-effective with regard to fall prevention in the whole sample and cost saving in the low disease severity group,when compared with usual care.","Mov Disord 31(Number): 53-61","Australia",2016,"Neuromuscular","Unspecified",null,"Adults","CEA,CUA","RCT"]
[26,"Fernandes,L.,et al. (2017). \"Supervised neuromuscular exercise prior to hip and knee replacement: 12-month clinical effect and cost-utility analysis alongside a randomised controlled trial.\" BMC Musculoskelet Disord 18(1): 5.",null,"Fernandes,L.,et al.","Supervised neuromuscular exercise prior to hip and knee replacement: 12-month clinical effect and cost-utility analysis alongside a randomised controlled trial","BACKGROUND: There are indications of beneficial short-term effect of pre-operative exercise in reducing pain and improving activity of daily living after total hip replacement (THR) and total knee replacement (TKR) surgery. Though,information from studies conducting longer follow-ups and economic evaluations of exercise prior to THR and TKR is needed. The aim of the study was to analyse 12-month clinical effect and cost-utility of supervised neuromuscular exercise prior to THR and TKR surgery. METHODS: The study was conducted alongside a randomised controlled trial including 165 patients scheduled for standard THR or TKR at a hospital located in a rural area of Denmark. The patients were randomised to replacement surgery with or without an 8-week preoperative supervised neuromuscular exercise program (Clinical Trials registration no.: NCT01003756). Clinical effect was measured with Hip disability and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Quality adjusted life years (QALYs) were based on EQ-5D-3L and Danish preference weights. Resource use was extracted from national registries and valued using standard tariffs (2012-EUR). Incremental net benefit was analysed to estimate the probability for the intervention being cost effective for a range of threshold values. A health care sector perspective was applied. RESULTS: HOOS/KOOS quality of life [8.25 (95% CI,0.42 to 16.10)] and QALYs [0.04 (95% CI,0.01 to 0.07)] were statistically significantly improved. Effect-sizes ranged between 0.09-0.59 for HOOS/KOOS subscales. Despite including an intervention cost of euro326 per patient,there was no difference in total cost between groups [euro132 (95% CI -3942 to 3679)]. At a threshold of euro40,000,preoperative exercise was found to be cost effective at 84% probability. CONCLUSION: Preoperative supervised neuromuscular exercise for 8 weeks was found to be cost-effective in patients scheduled for THR and TKR surgery at conventional thresholds for willingness to pay. One-year clinical effects were small to moderate and favoured the intervention group,but only statistically significant for quality of life measures. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01003756 ) October 28,2009.","BMC Musculoskelet Disord 18(Number): 5","Denmark",2017,"Musculoskeletal","Unspecified",null,"Unspecified","CUA","RCT"]
[27,"Gc,V.,et al. (2016). \"Are brief interventions to increase physical activity cost-effective? A systematic review.\" Br J Sports Med 50(7): 408-417.",null,"Gc,V.,et al.","Are brief interventions to increase physical activity cost-effective? A systematic review","OBJECTIVE: To determine whether brief interventions promoting physical activity are cost-effective in primary care or community settings. DESIGN: Systematic review of economic evaluations. METHODS AND DATA SOURCES: We searched MEDLINE,EMBASE,PsycINFO,CINAHL,EconLit,SPORTDiscus,PEDro,the Cochrane library,National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry up to 20 August 2014. Web of Knowledge was used for cross-reference search. We included studies investigating the cost-effectiveness of brief interventions,as defined by National Institute for Health and Care Excellence,promoting physical activity in primary care or the community. Methodological quality was assessed using Drummond's checklist for economic evaluations. Data were extracted from individual studies fulfilling selection criteria using a standardised pro forma. Comparisons of cost-effectiveness and cost-utility ratios were made between studies. RESULTS: Of 1840 identified publications,13 studies fulfilled the inclusion criteria describing 14 brief interventions. Studies varied widely in the methods used,such as the perspective of economic analysis,intervention effects and outcome measures. The incremental cost of moving an inactive person to an active state,estimated for eight studies,ranged from pound96 to pound986. The cost-utility was estimated in nine studies compared with usual care and varied from pound57 to pound14 002 per quality-adjusted life year; dominant to pound6500 per disability-adjusted life year; and pound15 873 per life years gained. CONCLUSIONS: Brief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care. Given the commonly accepted thresholds,they appear to be cost-effective on the whole,although there is notable variation between studies.","Br J Sports Med 50(Number): 408-417","UK",2016,"Unspecified","Unspecified",null,"Unspecified","CEA,CUA","SLR"]
[28,"Gc,V. S.,et al. (2018). \"Cost-Effectiveness and Value of Information Analysis of Brief Interventions to Promote Physical Activity in Primary Care.\" Value Health 21(1): 18-26.",null,"Gc,V. S.,et al.","Cost-Effectiveness and Value of Information Analysis of Brief Interventions to Promote Physical Activity in Primary Care","BACKGROUND: Brief interventions (BIs) delivered in primary care have shown potential to increase physical activity levels and may be cost-effective,at least in the short-term,when compared with usual care. Nevertheless,there is limited evidence on their longer term costs and health benefits. OBJECTIVES: To estimate the cost-effectiveness of BIs to promote physical activity in primary care and to guide future research priorities using value of information analysis. METHODS: A decision model was used to compare the cost-effectiveness of three classes of BIs that have been used,or could be used,to promote physical activity in primary care: 1) pedometer interventions,2) advice/counseling on physical activity,and (3) action planning interventions. Published risk equations and data from the available literature or routine data sources were used to inform model parameters. Uncertainty was investigated with probabilistic sensitivity analysis,and value of information analysis was conducted to estimate the value of undertaking further research. RESULTS: In the base-case,pedometer interventions yielded the highest expected net benefit at a willingness to pay of pound20,000 per quality-adjusted life-year. There was,however,a great deal of decision uncertainty: the expected value of perfect information surrounding the decision problem for the National Health Service Health Check population was estimated at pound1.85 billion. CONCLUSIONS: Our analysis suggests that the use of pedometer BIs is the most cost-effective strategy to promote physical activity in primary care,and that there is potential value in further research into the cost-effectiveness of brief (i.e.,<30 minutes) and very brief (i.e.,<5 minutes) pedometer interventions in this setting.","Value Health 21(Number): 18-26","UK",2018,"Unspecified","Walking",null,"Unspecified","CUA","SLR"]
[29,"Goode,A. D.,et al. (2015). \"Telephone,print,and Web-based interventions for physical activity,diet,and weight control among cancer survivors: a systematic review.\" J Cancer Surviv 9(4): 660-682.",null,"Goode,A. D.,et al.","Telephone,print,and Web-based interventions for physical activity,diet,and weight control among cancer survivors: a systematic review","PURPOSE: Broad-reach (non-face-to-face) modalities offer an accessible and cost-effective means to provide behavior change programs in diverse and growing cancer survivor populations. The purpose of this systematic review is to evaluate the efficacy of physical activity,dietary,and/or weight control interventions for cancer survivors in which telephone,short-message service,print,and/or Web is the primary method of delivery. METHODS: A structured search of PubMed,Embase,Web of Science,CINAHL,and CENTRAL (May 2013) was conducted. Included studies focused and reported on physical activity (PA) and dietary change and/or weight control in adult cancer survivors,delivered at least 50% of intervention contacts by broad-reach modality and included a control group. Study design,intervention features,and behavioral/weight outcomes were extracted,tabulated,and summarized. RESULTS: Twenty-seven studies were included; 22 telephone,three Web,and two print. Sixteen studies targeted PA,two diet,and nine targeted multiple behaviors. Most studies (18/27) targeted a single survivor group,namely breast cancer (n = 12). Nineteen of 27 studies found evidence for initiation of behavior change,with only eight reporting on maintenance and one on cost-effectiveness. CONCLUSIONS: This review provides support for broad-reach modalities,particularly the telephone,in the delivery of lifestyle interventions to cancer survivors. Future research should evaluate (1) newer technologies (i.e.,SMS and mobile phone applications),(2) interventions for diverse cancer survivors and those targeting multiple behaviors,(3) long-term outcomes,and 4) cost-effectiveness. IMPLICATIONS FOR CANCER SURVIVORS: Broad-reach lifestyle interventions are effective,with further research needed to evaluate their generalizability and integration into cancer care.","J Cancer Surviv 9(Number): 660-682","International",2015,"Cancer","Unspecified",null,"Adults","CEA","SLR"]
[30,"Goranitis,I.,et al. (2017). \"Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial.\" PLoS One 12(9): e0184328.",null,"Goranitis,I.,et al.","Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial","OBJECTIVE: To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms. DESIGN: Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective. SETTING: Primary care. POPULATION: Peri- and postmenopausal women who have not used hormone therapy in the past 3 months and experience >/= 5 episodes of vasomotor symptoms daily. METHODS: An individual and a social support-based exercise intervention were evaluated. The former (Exercise-DVD),aimed to prompt exercise with purpose-designed DVD and written materials,whereas the latter (Exercise-Social support) with community exercise social support groups. Costs and outcomes associated with these interventions were compared to those of a control group,who could only have an exercise consultation. An incremental cost-utility analysis was undertaken using bootstrapping to account for the uncertainty around cost-effectiveness point-estimates. MAIN OUTCOME MEASURE: Cost per quality-adjusted life-year (QALY). RESULTS: Data for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was pound52 (CIs: pound18 to pound86) and pound18 (CIs: - pound68 to pound105) more expensive per woman than the control group at 6 and 12 months post-randomisation and led to 0.006 (CIs: -0.002 to 0.014) and 0.013 (CIs: -0.01 to 0.036) more QALYs,resulting in an incremental cost-effectiveness ratio of pound8,940 and pound1,413 per QALY gained respectively. Exercise-Social support had 80%-90% probability of being cost-effective in the UK context. A societal perspective of analysis and a complete-case analysis led to similar findings. CONCLUSIONS: Exercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms.","PLoS One 12(Number): e0184328","UK",2017,"Various","Home Based Training",null,"Adults","CUA","RCT"]
[31,"Gordon,L. G.,et al. (2017). \"Cost-effectiveness of a pragmatic exercise intervention for women with breast cancer: results from a randomized controlled trial.\" Psychooncology 26(5): 649-655.",null,"Gordon,L. G.,et al.","Cost-effectiveness of a pragmatic exercise intervention for women with breast cancer: results from a randomized controlled trial","OBJECTIVE: To report on the cost-effectiveness of the Exercise for Health trial,comparing an exercise intervention with usual care during and following treatment for women with breast cancer. METHODS: Women with breast cancer were randomized to an 8-month exercise intervention (involving regular contact with an exercise physiologist over the phone,n = 67,or home delivered face to face,n = 67) or usual care (n = 60) group and were assessed pre-intervention (5 weeks post-surgery),mid-intervention (6 months post-surgery),and 10 weeks post-intervention (12 months post-surgery). The benefit measures were \"number of improvers\" in quality of life (FACT-B+4) and quality-adjusted life years (QALYs). Data on provider,patient,and government costs were used to consider 2 cost scenarios: (1) a service provider model and (2) a private model. RESULTS: There were 69 improvers in the intervention group compared with 21 in the usual care group (odds ratio 2.09,95% confidence interval 1.08,4.01; P = .033). The incremental cost per improver was A$2282 to A$2644. Quality-adjusted life years gain for the intervention group versus the usual care group was 0.009,with incremental cost per QALY gain for models 1 and 2 being A$105 231 and A$90 842,respectively. However,sensitivity analyses indicate that incremental cost per QALY gained was volatile to EuroQol-5D-3L weights. CONCLUSIONS: Findings suggest that a pragmatic exercise intervention yields more women with markedly improved quality of life after breast cancer than usual care and may be cost-effective. The results are less certain in terms of incremental cost per quality-adjusted life years; however,this may be an inappropriate measure for reflecting exercise benefit for women with breast cancer.","Psychooncology 26(Number): 649-655","Australia",2017,"Cancer","Physiotherapy",null,"Adults","CUA","RCT"]
[32,"Gordon,L. G.,et al. (2015). \"A telephone-delivered multiple health behaviour change intervention for colorectal cancer survivors: making the case for cost-effective healthcare.\" Eur J Cancer Care (Engl) 24(6): 854-861.",null,"Gordon,L. G.,et al.","A telephone-delivered multiple health behaviour change intervention for colorectal cancer survivors: making the case for cost-effective healthcare","UNLABELLED: In patients with colorectal cancer,a trial of a telephone-delivered multiple health behaviour change intervention,using acceptance commitment therapy strategies,found benefits for health and psychosocial outcomes including increased physical activity,improved dietary habits and lower body mass index. Our aim was to address the health economic outcomes by assessing the health system cost and health utility impacts of the intervention. A cost-consequences analysis was performed using data from a two-group randomised controlled intervention trial (n = 410). Outcomes included health-related quality of life (HRQoL),health utility and health system costs. At 12 months,clinically meaningful improvements were found for SF-6D over time but no significant differences were found between groups (P = 0.95). The cost of delivering the 6-month intervention was on average euro280 per person and made up 21% of overall healthcare costs for participants during the intervention period. Excluding intervention costs,costs were similar for health professional visits and medications across groups. Despite significant positive intervention effects on health behaviours,health utility and HRQoL scores were similar across groups. On the basis that intervention costs were small and physical activity,diet and weight management improved,on balance the intervention is potentially a worthwhile investment in healthcare funds. TRIAL REGISTRATION: ACTRN12608000399392.","Eur J Cancer Care (Engl) 24(Number): 854-861","Unclear",2015,"Cancer","Unspecified",null,"Unspecified","CCA","RCT"]
[33,"Gortmaker,S. L.,et al. (2015). \"Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES.\" Am J Prev Med 49(1): 102-111.",null,"Gortmaker,S. L.,et al.","Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES","INTRODUCTION: The childhood obesity epidemic continues in the U.S.,and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However,cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). METHODS: Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness,implementation,and equity issues were reviewed. RESULTS: Population reach varied widely,and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At 10 years,assuming maintenance of the intervention effect,three interventions would save net costs,with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years,and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue. CONCLUSIONS: The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money.","Am J Prev Med 49(Number): 102-111","USA",2015,"Various","Physical Exercise",null,"Children","CEA,CUA","Cohort"]
[34,"Gostin,L. O.,et al. (2017). \"Legal priorities for prevention of non-communicable diseases: innovations from WHO's Eastern Mediterranean region.\" Public Health 144: 4-12.",null,"Gostin,L. O.,et al.","Legal priorities for prevention of non-communicable diseases: innovations from WHO's Eastern Mediterranean region","OBJECTIVES: Non-communicable diseases (NCDs) are the leading cause of death globally and in the World Health Organization's (WHO) Eastern Mediterranean region (EMR). This paper reports on a research collaboration between the WHO's Eastern Mediterranean Office (EMRO) and the O'Neill Institute for National and Global Health Law at Georgetown University that aims to identify (1) regionally relevant,cost-effective and affordable legal interventions to prevent NCDs,and (2) methods to strengthen implementation and enforcement. STUDY DESIGN: Comparative analysis of >200 international,regional and domestic interventions addressing key NCD risk factors,including tobacco,alcohol,diet and physical inactivity. METHODS: Researchers searched legal and policy databases including the WHO Nutrition,Obesity and Physical Activity Database and drew upon academic commentary and 'grey' literature. Measures included evidence of impact; evidence of cost-effectiveness; and monitoring and enforcement mechanisms. RESULTS: Researchers identified many examples of legal interventions effectively reducing NCD risk factors. Key enabling factors for effective NCD-related laws include regulatory capacity; governance mechanisms promoting multisectoral collaboration and accountability; and tailoring interventions to local legal,economic and social contexts. CONCLUSIONS: In the EMR,and globally,law can be a cost-effective and affordable means of curbing underlying drivers of the NCD pandemic,such as rampant junk food marketing. Building upon this research,together with international and regional experts,EMRO has identified 10 priority interventions in the areas of tobacco control,unhealthy diets and NCD governance. The EMRO/O'Neill Institute partnership will develop guidance tools and capacity building initiatives to support Member States to harness the power of law to achieve population health improvements.","Public Health 144(Number): 4-12","Europe",2017,"Various","Unspecified",null,"Unspecified","CEA","SLR"]
[35,"Grande, A. J., et al. (2015). \"Exercise versus no exercise for the occurrence, severity and duration of acute respiratory infections.\" Cochrane Database Syst Rev (6): Cd010596.",null,"Grande, A. J., et al.","Exercise versus no exercise for the occurrence, severity and duration of acute respiratory infections","BACKGROUND: Acute respiratory infections (ARIs) last for less than 30 days and are the most common acute diseases affecting people worldwide. Exercise has been shown to improve health generally and may be effective in reducing the occurrence, severity and duration of acute respiratory infections. OBJECTIVES: To evaluate the effectiveness of exercise for altering the occurrence, severity or duration of acute respiratory infections. SEARCH METHODS: We searched CENTRAL (2014, Issue 6), MEDLINE (1948 to July week 1, 2014), EMBASE (2010 to July 2014), CINAHL (1981 to July 2014), LILACS (1982 to July 2014), SPORTDiscus (1985 to July 2014), PEDro (searched on 11 July 2014), OTseeker (searched on 11 July 2014), the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (searched on 11 July 2014). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of exercise for ARIs in the general population. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from the included trials using a standard form. We contacted trial authors to request missing data. One review author entered data and a second review author checked this. There were sufficient differences in the populations trialled and in the nature of the interventions to use the random-effects model (which makes fewer assumptions than the fixed-effect model) in the analysis. MAIN RESULTS: We included 11 trials involving 904 adults, published between 1990 and 2014. Eight studies were conducted in the USA, and one each in Canada, Spain and Turkey. Sample sizes ranged from 20 to 154 participants aged between 18 and 85 years old. The proportion of female participants varied between 52% and 100%. The duration of follow-up in the studies varied from seven days to 12 months. The exercise type most prescribed for the intervention was aerobic (walking in 70% of the studies, or bicycle riding or treadmill) at least five times a week. Duration was 30 to 45 minutes at moderate intensity. Participants were supervised in 90% of the studies.For four of the primary outcomes the results did not differ significantly and all were low-quality evidence (number of ARI episodes per person per year, rate ratio 0.91 (95% confidence interval (CI) 0.59 to 1.42); proportion of participants who experienced at least one ARI over the study period, risk ratio 0.76 (95% CI 0.57 to 1.01); severity of ARI symptoms, mean difference (MD) -110 (95% CI -324 to 104); and number of symptom days in the follow-up period, MD -2.1 days (95% CI -4.4 to 0.3)). However, one primary outcome, the number of symptom days per episode of illness, was reduced in those participants who exercised (MD -1.1 day, 95% CI -1.7 to -0.5, moderate-quality evidence).We found no significant differences for the secondary outcomes (laboratory parameters (blood lymphocytes, salivary secretory immunoglobulin and neutrophils); quality of life outcomes; cost-effectiveness and exercise-related injuries).There was good adherence to the intervention with no difference between the exercise and non-exercise groups.We rated the quality of evidence for the primary outcomes as low for most outcomes using the GRADE criteria: allocation concealment was not reported and there was a lack of blinding; in addition, there was imprecision (the CI is very wide because of a small number of participants) and inconsistency, which may be due to differences in study design. AUTHORS' CONCLUSIONS: We cannot determine whether exercise is effective at altering the occurrence, severity or duration of acute respiratory infections. One analysis of four trials suggests that the number of days of illness per episode of infection might be reduced by exercise. The small size of the studies, risk of bias and heterogeneous populations trialled all contribute to the uncertainty. Larger studies, with less risk of bias from patient selection, blinding of outcomes assessors, reporting of all outcomes measured and with registration of study protocols, are required to settle the question.","Cochrane Database Syst Rev Cd010596","International",2015,"Respiratory","Walking",null,"Adults","CEA","SLR"]
[36,"Groessl, E. J., et al. (2016). \"Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability.\" J Gerontol A Biol Sci Med Sci 71(5): 656-662.",null,"Groessl, E. J., et al.","Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability","BACKGROUND: Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention. METHODS: The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2x weekly, augmented with home-based activity to achieve a goal of 150 min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon. RESULTS: The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions. CONCLUSIONS: The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.","J Gerontol A Biol Sci Med Sci 71(Number): 656-662","USA",2016,"Various","Unspecified",null,"Elderly","CUA","RCT"]
[37,"Haas, M. and R. De Abreu Lourenco (2015). \"Pharmacological management of chronic lower back pain: a review of cost effectiveness.\" Pharmacoeconomics 33(6): 561-569.",null,"Haas, M. and R. De Abreu Lourenco","Pharmacological management of chronic lower back pain: a review of cost effectiveness","Lower back pain is one of the most prevalent musculoskeletal conditions in the developed world and accounts for significant health services use. The American College of Physicians and the American Pain Society have published a joint clinical guideline that recommends providing patients with information on prognosis and self-management, the use of medications with proven benefits and, for those who do not improve, consideration be given to the use of spinal manipulation (for acute lower back pain only), interdisciplinary rehabilitation, exercise, acupuncture, massage, yoga, cognitive behavioural therapy or relaxation. The purpose of this review was to evaluate published economic evaluations of pharmacological management for chronic lower back pain. A total of seven studies were eligible for inclusion in there view. The quality of the economic evaluations undertaken in the included studies was not high. This was primarily because of the nature of the underlying clinical evidence, most of which did not come from rigorous randomised controlled trials (RCTs), and the manner in which it was incorporated into the economic evaluations. All studies provided reasonable information about what aspects of healthcare and other resource use were identified, measured and valued. However, the reporting of total costs was not uniform across studies. Measures of pain and disability were the most commonly collected outcomes measures. Two studies collected information on quality of life directly from participants while two studies modelled this information based on the literature. Future economic evaluations of interventions for chronic lower back pain, including pharmacological interventions, should be based on the results of well-conducted RCTs where the measurement of costs and outcomes such as quality of life and quality-adjusted life-years is included in the trial protocol, and which have a follow-up period sufficient to capture meaningful changes in both costs and outcomes. In the absence of RCT data, economic models should be used to estimate future costs and outcomes using robust methods.","Pharmacoeconomics 33(Number): 561-569","International",2015,"Musculoskeletal","Unspecified",null,"Unspecified","CUA,CEA","SLR"]
[38,"Hautala, A. J., et al. (2017). \"Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome.\" Scand J Med Sci Sports 27(11): 1395-1403.",null,"Hautala, A. J., et al.","Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome","Health care decision-making requires evidence of the cost-effectiveness of medical therapies. We evaluated the cost-effectiveness of exercise-based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n = 204) had experienced a recent acute coronary syndrome and were randomized to a 1-year ECR (n = 109) or usual care (UC) group (n = 95). The patients' health-related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost-effectiveness of ECR was estimated based on intervention and health care costs and quality-adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline-adjusted incremental QALYs (0.045), yielding an incremental cost-effectiveness ratio of -euro24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4-10.6, P = 0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision-making when planning optimal utilization of resources in Finnish health care.","Scand J Med Sci Sports 27(Number): 1395-1403","Finland",2017,"Cardiovascular","Unspecified",null,"Unspecified","CUA","Cohort"]
[39,"Johnson, M. J., et al. (2015). \"A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease.\" BMC Med 13: 213.",null,"Johnson, M. J., et al.","A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease","BACKGROUND: About 90 % of patients with intra-thoracic malignancy experience breathlessness. Breathing training is helpful, but it is unknown whether repeated sessions are needed. The present study aims to test whether three sessions are better than one for breathlessness in this population. METHODS: This is a multi-centre randomised controlled non-blinded parallel arm trial. Participants were allocated to three sessions or single (1:2 ratio) using central computer-generated block randomisation by an independent Trials Unit and stratified for centre. The setting was respiratory, oncology or palliative care clinics at eight UK centres. Inclusion criteria were people with intrathoracic cancer and refractory breathlessness, expected prognosis >/=3 months, and no prior experience of breathing training. The trial intervention was a complex breathlessness intervention (breathing training, anxiety management, relaxation, pacing, and prioritisation) delivered over three hour-long sessions at weekly intervals, or during a single hour-long session. The main primary outcome was worst breathlessness over the previous 24 hours ('worst'), by numerical rating scale (0 = none; 10 = worst imaginable). Our primary analysis was area under the curve (AUC) 'worst' from baseline to 4 weeks. All analyses were by intention to treat. RESULTS: Between April 2011 and October 2013, 156 consenting participants were randomised (52 three; 104 single). Overall, the 'worst' score reduced from 6.81 (SD, 1.89) to 5.84 (2.39). Primary analysis [n = 124 (79 %)], showed no between-arm difference in the AUC: three sessions 22.86 (7.12) vs single session 22.58 (7.10); P value = 0.83); mean difference 0.2, 95 % CIs (-2.31 to 2.97). Complete case analysis showed a non-significant reduction in QALYs with three sessions (mean difference -0.006, 95 % CIs -0.018 to 0.006). Sensitivity analyses found similar results. The probability of the single session being cost-effective (threshold value of pound20,000 per QALY) was over 80 %. CONCLUSIONS: There was no evidence that three sessions conferred additional benefits, including cost-effectiveness, over one. A single session of breathing training seems appropriate and minimises patient burden. TRIAL REGISTRATION: Registry: ISRCTN; TRIAL REGISTRATION NUMBER: ISRCTN49387307; http://www.isrctn.com/ISRCTN49387307 ; registration date: 25/01/2011.","BMC Med 13(Number): 213","UK",2015,"Cancer","Breathing Techniques",null,"Unspecified","CUA","RCT"]
[40,"Johnson, T. J., et al. (2016). \"The Cost of Increasing Physical Activity and Maintaining Weight for Midlife Sedentary African American Women.\" Value Health 19(1): 20-27.",null,"Johnson, T. J., et al.","The Cost of Increasing Physical Activity and Maintaining Weight for Midlife Sedentary African American Women","OBJECTIVE: To evaluate the marginal costs of increasing physical activity and maintaining weight for a lifestyle physical activity program targeting sedentary African American women. METHODS: Outcomes included change in minutes of total moderate to vigorous physical activity, leisure-time moderate to vigorous physical activity and walking per week, and weight stability between baseline and maintenance at 48 weeks. Marginal cost-effectiveness ratios (MCERs) were calculated for each outcome, and 95% confidence intervals (CIs) were computed using a bootstrap method. The analysis was carried out from the societal perspective and calculated in 2013 US dollars. RESULTS: For the 260 participants in the analysis, program costs were $165 +/- $19, and participant costs were $164 +/- $35, for a total cost of $329 +/- $49. The MCER for change in walking was $1.50/min/wk (95% CI 1.28-1.87), for change in moderate to vigorous physical activity was $1.73/min/wk (95% CI 1.41-2.18), and for leisure-time moderate to vigorous physical activity was $1.94/min/wk (95% CI 1.58-2.40). The MCER for steps based on the accelerometer was $0.46 per step (95% CI 0.30-0.85) and weight stability was $412 (95% CI 399-456). CONCLUSIONS: The Women's Lifestyle Physical Activity Program is a relatively low-cost strategy for increasing physical activity. The marginal cost of increasing physical activity is lower than for weight stability. The participant costs related to time in the program were nearly half the total costs, suggesting that practitioners and policymakers should consider the participant cost when disseminating a lifestyle physical activity program into practice.","Value Health 19(Number): 20-27","USA",2016,"None","Multiple",null,"Adults","CEA","Cohort"]
[41,"Jordan, R. E., et al. (2015). \"Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis.\" Health Technol Assess 19(36): 1-516.",null,"Jordan, R. E., et al.","Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis","BACKGROUND: Self-management (SM) support for patients with chronic obstructive pulmonary disease (COPD) is variable in its coverage, content, method and timing of delivery. There is insufficient evidence for which SM interventions are the most effective and cost-effective. OBJECTIVES: To undertake (1) a systematic review of the evidence for the effectiveness of SM interventions commencing within 6 weeks of hospital discharge for an exacerbation for COPD (review 1); (2) a systematic review of the qualitative evidence about patient satisfaction, acceptance and barriers to SM interventions (review 2); (3) a systematic review of the cost-effectiveness of SM support interventions within 6 weeks of hospital discharge for an exacerbation of COPD (review 3); (4) a cost-effectiveness analysis and economic model of post-exacerbation SM support compared with usual care (UC) (economic model); and (5) a wider systematic review of the evidence of the effectiveness of SM support, including interventions (such as pulmonary rehabilitation) in which there are significant components of SM, to identify which components are the most important in reducing exacerbations, hospital admissions/readmissions and improving quality of life (review 4). METHODS: The following electronic databases were searched from inception to May 2012: MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Science Citation Index [Institute of Scientific Information (ISI)]. Subject-specific databases were also searched: PEDro physiotherapy evidence database, PsycINFO and the Cochrane Airways Group Register of Trials. Ongoing studies were sourced through the metaRegister of Current Controlled Trials, International Standard Randomised Controlled Trial Number database, World Health Organization International Clinical Trials Registry Platform Portal and ClinicalTrials.gov. Specialist abstract and conference proceedings were sourced through ISI's Conference Proceedings Citation Index and British Library's Electronic Table of Contents (Zetoc). Hand-searching through European Respiratory Society, the American Thoracic Society and British Thoracic Society conference proceedings from 2010 to 2012 was also undertaken, and selected websites were also examined. Title, abstracts and full texts of potentially relevant studies were scanned by two independent reviewers. Primary studies were included if approximately 90% of the population had COPD, the majority were of at least moderate severity and reported on any intervention that included a SM component or package. Accepted study designs and outcomes differed between the reviews. Risk of bias for randomised controlled trials (RCTs) was assessed using the Cochrane tool. Random-effects meta-analysis was used to combine studies where appropriate. A Markov model, taking a 30-year time horizon, compared a SM intervention immediately following a hospital admission for an acute exacerbation with UC. Incremental costs and quality-adjusted life-years were calculated, with sensitivity analyses. RESULTS: From 13,355 abstracts, 10 RCTs were included for review 1, one study each for reviews 2 and 3, and 174 RCTs for review 4. Available studies were heterogeneous and many were of poor quality. Meta-analysis identified no evidence of benefit of post-discharge SM support on admissions [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.52 to 1.17], mortality (HR 1.07, 95% CI 0.74 to 1.54) and most other health outcomes. A modest improvement in health-related quality of life (HRQoL) was identified but this was possibly biased due to high loss to follow-up. The economic model was speculative due to uncertainty in impact on readmissions. Compared with UC, post-discharge SM support (delivered within 6 weeks of discharge) was more costly and resulted in better outcomes ( pound683 cost difference and 0.0831 QALY gain). Studies assessing the effect of individual components were few but only exercise significantly improved HRQoL (3-month St George's Respiratory Questionnaire 4.87, 95% CI 3.96 to 5.79). Multicomponent interventions produced an improved HRQoL compared with UC (mean difference 6.50, 95% CI 3.62 to 9.39, at 3 months). Results were consistent with a potential reduction in admissions. Interventions with more enhanced care from health-care professionals improved HRQoL and reduced admissions at 1-year follow-up. Interventions that included supervised or unsupervised structured exercise resulted in significant and clinically important improvements in HRQoL up to 6 months. LIMITATIONS: This review was based on a comprehensive search strategy that should have identified most of the relevant studies. The main limitations result from the heterogeneity of studies available and widespread problems with their design and reporting. CONCLUSIONS: There was little evidence of benefit of providing SM support to patients shortly after discharge from hospital, although effects observed were consistent with possible improvement in HRQoL and reduction in hospital admissions. It was not easy to tease out the most effective components of SM support packages, although interventions containing exercise seemed the most effective. Future work should include qualitative studies to explore barriers and facilitators to SM post exacerbation and novel approaches to affect behaviour change, tailored to the individual and their circumstances. Any new trials should be properly designed and conducted, with special attention to reducing loss to follow-up. Individual participant data meta-analysis may help to identify the most effective components of SM interventions. STUDY REGISTRATION: This study is registered as PROSPERO CRD42011001588. FUNDING: The National Institute for Health Research Health Technology Assessment programme.","Health Technol Assess 19(Number): 1-516","UK",2015,"Respiratory","Unspecified",null,"Unspecified","CUA","SLR"]
[42,"Kolu, P., et al. (2015). \"Cost-effectiveness of physical activity among women with menopause symptoms: findings from a randomised controlled trial.\" PLoS One 10(8): e0135099.",null,"Kolu, P., et al.","Cost-effectiveness of physical activity among women with menopause symptoms: findings from a randomised controlled trial","Menopause is a period that may predispose one to a decrease in muscle strength, cardiorespiratory fitness, and quality of life. A study was carried out to evaluate the cost-effectiveness of physical activity among women displaying symptoms of menopause. The cost-effectiveness analysis was based on data from a six-month randomised controlled trial (n = 151). The women in the intervention group engaged in an unsupervised session of at least 50 minutes of physical activity four times a week. The control group continued their physical activity as before. An incremental cost-effectiveness ratio (ICER) was calculated in terms of maximal oxygen consumption, lean muscle mass, and quality-adjusted life years (QALYs) gained. A bootstrap technique was utilised to estimate uncertainty around the point estimate for ICER associated with the intervention. The mean total cost in the intervention group was euro1,307 (SEM: euro311) and in the control group was euro1,253 (SEM: euro279, p = 0.10) per person. The mean intervention cost was euro208 per person. After six months of the behaviour-change intervention, the ICER was euro63 for a 1 ml/kg/min improvement in cardiorespiratory fitness, the additional cost per one-gram increase in lean muscle mass was euro126, and the cost per QALY gained was euro46. According to the findings, physical activity among menopausal women was cost-effective for cardiorespiratory fitness, for lean muscle mass, and for QALYs gained, since the intervention was more effective than the actions within the control group and the additional effects of physical activity were gained at a very low price. From the societal perspective, the intervention used may promote ability to work and thereby save on further costs associated with early retirement or disability pension if the physical-activity level remains at least the same as during the intervention.","PLoS One 10(Number): e0135099","Finland",2015,"Various","Unspecified",null,"Unspecified","CUA","RCT"]
[43,"Kolu, P., et al. (2016). \"Effectiveness and Cost-Effectiveness of a Cluster-Randomized Prenatal Lifestyle Counseling Trial: A Seven-Year Follow-Up.\" PLoS One 11(12): e0167759.",null,"Kolu, P., et al.","Effectiveness and Cost-Effectiveness of a Cluster-Randomized Prenatal Lifestyle Counseling Trial: A Seven-Year Follow-Up","There is a link between the pregnancy and its long-term influence on health and susceptibility to future chronic disease both in mother and offspring. The objective was to determine whether individual counseling on physical activity and diet and weight gain at five antenatal visits can prevent type 2 diabetes mellitus (T2DM) and overweight or improve glycemic parameters, among all at-risk-mothers and their children. Another objective was to evaluate whether gestational lifestyle intervention was cost-effective as measured with mother's sickness absence and quality-adjusted life years (QALY). This study was a seven-year follow-up study for women, who were enrolled to the antenatal cluster-randomized controlled trial (RCT). Analysis of the outcome included all women whose outcome was available, in addition with subgroup analysis including women adherent to all lifestyle aims. A total of 173 women with their children participated to the study, representing 43% (173/399) of the women who finished the original RCT. Main outcome measures were: T2DM based on medication use or fasting blood glucose or oral glucose tolerance test (OGTT), body mass index (BMI), glycosylated hemoglobin (HbA1c). None of the women were diagnosed to have T2DM. HbA1c or fasting blood glucose differences were not found among mothers or children. Differences in BMI were non-significant among mothers (Intervention 27.3, Usual care 28.1 kg/m2, p = 0.33) and children (I 21.3 vs U 22.5 kg/m2, p = 0.07). Children's BMI was significantly lower among adherent group (I 20.5 vs U 22.5, p = 0.04). The mean total cost per person was 30.6% lower in the intervention group than in the usual care group (I euro2,944 vs. U euro4,243; p = 0.74). Intervention was cost-effective in terms of sickness absence but not in QALY gained i.e. if society is willing to pay additional euro100 per one avoided sickness absence day; there is a 90% probability of the intervention arm to be cost-effective. Long-term effectiveness of antenatal lifestyle counseling was not shown, in spite of possible effect on children's BMI. Cost-effectiveness of the intervention in terms of sickness absence may have larger societal impact.","PLoS One 11(Number): e0167759","Finland",2016,"None","Unspecified",null,"Children,Adults","CUA,CEA","RCT"]
[44,"Kraal, J. J., et al. (2017). \"Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study.\" Eur J Prev Cardiol 24(12): 1260-1273.",null,"Kraal, J. J., et al.","Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study","Aim Although cardiac rehabilitation improves physical fitness after a cardiac event, many eligible patients do not participate in cardiac rehabilitation and the beneficial effects of cardiac rehabilitation are often not maintained over time. Home-based training with telemonitoring guidance could improve participation rates and enhance long-term effectiveness. Methods and results We randomised 90 low-to-moderate cardiac risk patients entering cardiac rehabilitation to three months of either home-based training with telemonitoring guidance or centre-based training. Although training adherence was similar between groups, satisfaction was higher in the home-based group ( p = 0.02). Physical fitness improved at discharge ( p < 0.01) and at one-year follow-up ( p < 0.01) in both groups, without differences between groups (home-based p = 0.31 and centre-based p = 0.87). Physical activity levels did not change during the one-year study period (centre-based p = 0.38, home-based p = 0.80). Healthcare costs were statistically non-significantly lower in the home-based group (euro437 per patient, 95% confidence interval -562 to 1436, p = 0.39). From a societal perspective, a statistically non-significant difference of euro3160 per patient in favour of the home-based group was found (95% confidence interval -460 to 6780, p = 0.09) and the probability that it was more cost-effective varied between 97% and 75% (willingness-to-pay of euro0 and euro100,000 per quality-adjusted life-years, respectively). Conclusion We found no differences between home-based training with telemonitoring guidance and centre-based training on physical fitness, physical activity level or health-related quality of life. However, home-based training was associated with a higher patient satisfaction and appears to be more cost-effective than centre-based training. We conclude that home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients entering cardiac rehabilitation.","Eur J Prev Cardiol 24(Number): 1260-1273","Netherlands",2017,"Various","Home Based Training",null,"Unspecified","CUA","RCT"]
[45,"Landen Ludvigsson, M., et al. (2017). \"Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders: Analyses of a randomized clinical trial.\" Medicine (Baltimore) 96(25): e7274.",null,"Landen Ludvigsson, M., et al.","Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders: Analyses of a randomized clinical trial","BACKGROUND: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered. OBJECTIVE: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3. METHODS: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made. RESULTS: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$ 12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower. CONCLUSION: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.","Medicine (Baltimore) 96(Number): e7274","USA",2017,"Musculoskeletal","Physiotherapy",null,"Unspecified","CUA","RCT"]
[46,"Larsen, B., et al. (2015). \"Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control.\" Int J Behav Nutr Phys Act 12: 140.",null,"Larsen, B., et al.","Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control","BACKGROUND: Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas. METHODS: Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) using the 7-Day Physical Activity Recall Interview. Costs were calculated from a payer perspective, and included personnel time (wage, fringe, and overhead), materials, equipment, software, and postage costs. RESULTS: At six months, the PA intervention cost $29/person/month, compared to $15/person/month for wellness control. These costs fell to $17 and $9 at 12 months, respectively. Intervention participants increased their PA by an average of 72 min/week at six months and 94 min/week at 12 months, while wellness control participants increased their PA by an average of 30 min/week and 40 min/week, respectively. At six months, each minute increase in PA cost $0.18 in the intervention group compared to $0.23 in wellness control, which fell to $0.07 and $0.08 at 12 months, respectively. The incremental cost per increase in physical activity associated with the intervention was $0.15 at 6 months and $0.05 at 12 months. CONCLUSIONS: While the intervention was more costly than the wellness control, costs per minute of increase in PA were lower in the intervention. The print-based mail-delivered format has potential for broad, cost-effective dissemination, which could help address disparities in this at-risk population. TRIAL REGISTRATION: NCT01583140; Date of Registration: 03/06/2012; Funding Source of Trial: National Institute of Nursing Research (NINR); Name of Institutional Review Board: Brown University IRB; Date of Approval: 05/19/2009.","Int J Behav Nutr Phys Act 12(Number): 140","USA",2015,"Unspecified","Unspecified",null,"Unspecified","CEA","RCT"]
[47,"Larsen, B., et al. (2017). \"A Web-Based Physical Activity Intervention for Spanish-Speaking Latinas: A Costs and Cost-Effectiveness Analysis.\" J Med Internet Res 19(2): e43.",null,"Larsen, B., et al.","A Web-Based Physical Activity Intervention for Spanish-Speaking Latinas: A Costs and Cost-Effectiveness Analysis","BACKGROUND: Latinas report particularly low levels of physical activity and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that can increase physical activity in this growing population in a large-scale, cost-effective manner. Web-based interventions may have potential given the increase in Internet use among Latinas and the scalability of Web-based programs. OBJECTIVE: To examine the costs and cost-effectiveness of a Web-based, Spanish-language physical activity intervention for Latinas compared to a wellness contact control. METHODS: Healthy adult Latina women (N=205) were recruited from the community and randomly assigned to receive a Spanish-language, Web-based, individually tailored physical activity intervention (intervention group) or were given access to a website with content on wellness topics other than physical activity (control group). Physical activity was measured using the 7-Day Physical Activity Recall interview and ActiGraph accelerometers at baseline, 6 months (ie, postintervention), and 12 months (ie, maintenance phase). Costs were estimated from a payer perspective and included all features necessary to implement the intervention in a community setting, including staff time (ie, wages, benefits, and overhead), materials, hardware, website hosting, and routine website maintenance. RESULTS: At 6 months, the costs of running the intervention and control groups were US $17 and US $8 per person per month, respectively. These costs fell to US $12 and US $6 per person per month at 12 months, respectively. Linear interpolation showed that intervention participants increased their physical activity by 1362 total minutes at 6 months (523 minutes by accelerometer) compared to 715 minutes for control participants (186 minutes by accelerometer). At 6 months, each minute increase in physical activity for the intervention group cost US $0.08 (US $0.20 by accelerometer) compared to US $0.07 for control participants (US $0.26 by accelerometer). Incremental cost-per-minute increases associated with the intervention were US $0.08 at 6 months and US $0.04 at 12 months (US $0.16 and US $0.08 by accelerometer, respectively). Sensitivity analyses showed variations in staffing costs or intervention effectiveness yielded only modest changes in incremental costs. CONCLUSIONS: While the Web-based physical activity intervention was more expensive than the wellness control, both were quite low cost compared to face-to-face or mail-delivered interventions. Cost-effectiveness ranged markedly based on physical activity measure and was similar between the two conditions. Overall, the Web-based intervention was effective and low cost, suggesting a promising channel for increasing physical activity on a large scale in this at-risk population. CLINICALTRIAL: Clinicaltrials.gov NCT01834287; https://clinicaltrials.gov/ct2/show/NCT01834287 (Archived by WebCite at http://www.webcitation.org/6nyjX9Jrh).","J Med Internet Res 19(Number): e43","USA",2017,"Unspecified","Unspecified",null,"Adults","CEA","RCT"]
[48,"Larsen, K. T., et al. (2017). \"Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up.\" Scand J Public Health 45(6): 666-674.",null,"Larsen, K. T., et al.","Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up","AIMS: The aim was to analyse the cost-effectiveness of an intensive weight-loss intervention for children compared with a low-intensity intervention. METHODS: One hundred and fifteen overweight children (mean age 12.0 +/- 0.4) were randomised to either the camp group (CG) ( N=59) or the standard group (SG) ( N=56). Participants in the CG were offered a six-week day-camp weight-loss programme followed by a family-based supportive programme containing four meetings during the succeeding 46 weeks. Participants in the SG were offered a weekly two-hour exercise session for six weeks. Changes in body mass index (BMI) and BMI z-score 12 months after inclusion were used to compare the effects of the two interventions. Incremental cost-effectiveness ratios (ICER) were estimated from the perspective of a Danish municipality. To achieve the required number of participants, an additional intervention was initiated one year later. RESULTS: In comparison with the SG, the CG changed their mean BMI by -1.2 (95% CI -1.8 to -0.5). Compared with the SG children, the CG children changed their BMI z-score by -0.20 (95% CI -0.35 to -0.05). The ICER per decreased BMI point in the CG compared with the SG was DDK 24,928. CONCLUSIONS: Compared with the SG, the CG showed favourable effects after 12 months. However, the CG was more costly. The results observed in the present study may be helpful in guiding decision makers to take more informed decisions when choosing different types of intervention.","Scand J Public Health 45(Number): 666-674","Denmark",2017,"None","Day Camp",null,"Children","CEA","RCT"]
[49,"Leininger, B., et al. (2016). \"Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain.\" Spine J 16(11): 1292-1304.",null,"Leininger, B., et al.","Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain","BACKGROUND CONTEXT: Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments. PURPOSE: This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA. STUDY DESIGN/SETTING: Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed. PATIENT SAMPLE: A total of 241 older adults (>/=65 years) with chronic mechanical neck pain comprised the patient sample. OUTCOME MEASURES: The outcome measures were direct and indirect costs, neck pain, neck disability, SF-6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1-year time horizon. METHODS: This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425). The RCT is registered at ClinicalTrials.gov (#NCT00269308). A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectivenesswas a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates. RESULTS: Total costs for SMT+HEA were 5% lower than HEA (mean difference: -$111; 95% confidence interval [CI] -$1,354 to $899) and 47% lower than SRE+HEA (mean difference: -$1,932; 95% CI -$2,796 to -$1,097). SMT+HEA also resulted in a greater reduction of neck pain over the year relative to HEA (0.57; 95% CI 0.23 to 0.92) and SRE+HEA (0.41; 95% CI 0.05 to 0.76). Differences in disability and QALYs favored SMT+HEA. The probability that adding SMT to HEA is cost-effective at willingness to pay thresholds of $50,000 to $200,000 per QALY gained ranges from 0.75 to 0.81. If adopting a health-care perspective, costs for SMT+HEA were 66% higher than HEA (mean difference: $515; 95% CI $225 to $1,094), resulting in an ICER of $55,975 per QALY gained. CONCLUSION: On average, SMT+HEA resulted in better clinical outcomes and lower total societal costs relative to SRE+HEA and HEA alone, with a 0.75 to 0.81 probability of cost-effectiveness for willingness to pay thresholds of $50,000 to $200,000 per QALY.","Spine J 16(Number): 1292-1304","USA",2016,"Musculoskeletal","Unspecified",null,"Adults","CUA","RCT"]
[50,"Li, F. and P. Harmer (2015). \"Economic Evaluation of a Tai Ji Quan Intervention to Reduce Falls in People With Parkinson Disease, Oregon, 2008-2011.\" Prev Chronic Dis 12: E120.",null,"Li, F. and P. Harmer","Economic Evaluation of a Tai Ji Quan Intervention to Reduce Falls in People With Parkinson Disease, Oregon, 2008-2011","INTRODUCTION: Exercise is effective in reducing falls in people with Parkinson disease. However, information on the cost effectiveness of this approach is lacking. We conducted a cost-effectiveness analysis of Tai Ji Quan for reducing falls among patients with mild-to-moderate Parkinson disease. METHODS: We used data from a previous intervention trial to analyze resource use costs related to intervention delivery and number of falls observed during a 9-month study period. Cost effectiveness was estimated via incremental cost-effectiveness ratio (ICER) in which Tai Ji Quan was compared with 2 alternative interventions (Resistance training and Stretching) on the primary outcome of per fall prevented and the secondary outcome of per participant quality-adjusted life years (QALY) gained. We also conducted subgroup and sensitivity analyses. RESULTS: Tai Ji Quan was more effective than either Resistance training or Stretching; it had the lowest cost and was the most effective in improving primary and secondary outcomes. Compared with Stretching, Tai Ji Quan cost an average of $175 less for each additional fall prevented and produced a substantial improvement in QALY gained at a lower cost. Results from subgroup and sensitivity analyses showed no variation in cost-effectiveness estimates. However, sensitivity analyses demonstrated a much lower ICER ($27) when only intervention costs were considered. CONCLUSION: Tai Ji Quan represents a cost-effective strategy for optimizing spending to prevent falls and maximize health gains in people with Parkinson disease. While these results are promising, they warrant further validation.","Prev Chronic Dis 12(Number): E120","USA",2015,"Neuromuscular","Tai ji Quan",null,"Unspecified","CUA,CEA","RCT"]
[51,"Li, F., et al. (2016). \"Implementing an Evidence-Based Fall Prevention Intervention in Community Senior Centers.\" Am J Public Health 106(11): 2026-2031.",null,"Li, F., et al.","Implementing an Evidence-Based Fall Prevention Intervention in Community Senior Centers","OBJECTIVES: To evaluate the impact of implementing an evidence-based fall prevention intervention in community senior centers. METHODS: We used a single-group design to evaluate the Tai Ji Quan: Moving for Better Balance (TJQMBB) program's adoption, population reach, implementation, effectiveness, and maintenance among 36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month postintervention follow-up. RESULTS: TJQMBB was adopted by 89% of the senior centers approached and reached 90% of the target population. The program resulted in a 49% reduction in the total number of falls and improved physical performance. Participation was well maintained after the program's completion. The average cost-effectiveness ratio for the 48-week program implementation was $917 per fall prevented and $676 per fall prevented for multiple falls. CONCLUSIONS: TJQMBB is an effective public health program that can be broadly implemented in community senior centers for primary prevention of falls among community-dwelling older adults.","Am J Public Health 106(Number): 2026-2031","USA",2016,"None","Home Based Training",null,"Adults","CEA","RCT"]
[52,"Li, R., et al. (2015). \"Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force.\" Ann Intern Med 163(6): 452-460.",null,"Li, R., et al.","Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force","BACKGROUND: Diabetes is a highly prevalent and costly disease. Studies indicate that combined diet and physical activity promotion programs can prevent type 2 diabetes among persons at increased risk. PURPOSE: To systematically evaluate the evidence on cost, cost-effectiveness, and cost-benefit estimates of diet and physical activity promotion programs. DATA SOURCES: Cochrane Library, EMBASE, MEDLINE, PsycINFO, Sociological Abstracts, Web of Science, EconLit, and CINAHL through 7 April 2015. STUDY SELECTION: English-language studies from high-income countries that provided data on cost, cost-effectiveness, or cost-benefit ratios of diet and physical activity promotion programs with at least 2 sessions over at least 3 months delivered to persons at increased risk for type 2 diabetes. DATA EXTRACTION: Dual abstraction and assessment of relevant study details. DATA SYNTHESIS: Twenty-eight studies were included. Costs were expressed in 2013 U.S. dollars. The median program cost per participant was $653. Costs were lower for group-based programs (median, $417) and programs implemented in community or primary care settings (median, $424) than for the U.S. DPP (Diabetes Prevention Program) trial and the DPP Outcomes Study ($5881). Twenty-two studies assessed the incremental cost-effectiveness ratios (ICERs) of the programs. From a health system perspective, 16 studies reported a median ICER of $13 761 per quality-adjusted life-year (QALY) saved. Group-based programs were more cost-effective (median, $1819 per QALY) than those that used individual sessions (median, $15 846 per QALY). No cost-benefit studies were identified. LIMITATION: Information on recruitment costs and cost-effectiveness of translational programs implemented in community and primary care settings was limited. CONCLUSION: Diet and physical activity promotion programs to prevent type 2 diabetes are cost-effective among persons at increased risk. Costs are lower when programs are delivered to groups in community or primary care settings. PRIMARY FUNDING SOURCE: None.","Ann Intern Med 163(Number): 452-460","USA",2015,"None","Unspecified",null,"Unspecified","CUA","SLR"]
[53,"Little, P., et al. (2017). \"Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction).\" Health Technol Assess 21(4): 1-62.",null,"Little, P., et al.","Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)","BACKGROUND: Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed. OBJECTIVES: To estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice. DESIGN: Individually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews. SETTING: Primary care general practices in the UK. PARTICIPANTS: Patients with a body mass index of >/= 30 kg/m(2) (or >/= 28 kg/m(2) with risk factors) identified from general practice records, recruited by postal invitation. INTERVENTIONS: Positive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls). MAIN OUTCOME MEASURES: The primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months. RESULTS: A total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control, n = 227; POWeR+F, n = 221; POWeR+R, n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg; p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg; p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51; p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74; p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was pound18 (95% CI - pound129 to pound195) for POWeR+F and - pound25 (95% CI - pound268 to pound157) for POWeR+R. The probability of being cost-effective at a threshold of pound100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+. STUDY LIMITATIONS: Maintenance of weight loss after 1 year is unknown. FUTURE WORK: Identifying strategies for longer-term engagement, impact in community settings and increasing physical activity. CONCLUSION: Clinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective. TRIAL REGISTRATION: Current Controlled Trials ISRCTN21244703. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.","Health Technol Assess 21(Number): 1-62","UK",2017,"Various","Home Based Training",null,"Adults","CEA","RCT"]
[54,"Manning, V. L., et al. (2015). \"Economic evaluation of a brief education, self-management and upper limb exercise training in people with rheumatoid arthritis (EXTRA) programme: a trial-based analysis.\" Rheumatology (Oxford) 54(2): 302-309.",null,"Manning, V. L., et al.","Economic evaluation of a brief education, self-management and upper limb exercise training in people with rheumatoid arthritis (EXTRA) programme: a trial-based analysis","OBJECTIVE: The aim of this study was to conduct a cost-utility analysis of the Education, Self-management and Upper Limb Exercise Training in People with RA (EXTRA) programme compared with usual care. METHODS: A within-trial incremental cost-utility analysis was conducted with 108 participants randomized to either the EXTRA programme (n = 52) or usual care (n = 56). A health care perspective was assumed for the primary analysis with a 36 week follow-up. Resource use information was collected on interventions, medication, primary and secondary care contacts, private health care and social care costs. Quality-adjusted life years (QALYs) were calculated from the EuroQol five-dimension three-level (EQ-5D-3L) questionnaire responses at baseline, 12 and 36 weeks. RESULTS: Compared with usual care, total QALYs gained were higher in the EXTRA programme, leading to an increase of 0.0296 QALYs. The mean National Health Service (NHS) costs per participant were slightly higher in the EXTRA programme (by pound82), resulting in an incremental cost-effectiveness ratio of pound2770 per additional QALY gained. Thus the EXTRA programme was cost effective from an NHS perspective when assessed against the threshold of pound20 000- pound30 000/QALY gained. Overall, costs were lower in the EXTRA programme compared with usual care, suggesting it was the dominant treatment option from a societal perspective. At a willingness-to-pay of pound20 000/QALY gained, there was a 65% probability that the EXTRA programme was the most cost-effective option. These results were robust to sensitivity analyses accounting for missing data, changing the cost perspective and removing cost outliers. CONCLUSION: The physiotherapist-led EXTRA programme represents a cost-effective use of resources compared with usual care and leads to lower health care costs and work absence. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number Register; http://www.controlled-trials.com/isrctn/ (ISRCTN14268051).","Rheumatology (Oxford) 54(Number): 302-309","UK",2015,"Musculoskeletal","Unspecified",null,"Unspecified","CUA","RCT"]
[55,"May, A. M., et al. (2017). \"Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study.\" BMJ Open 7(3): e012187.",null,"May, A. M., et al.","Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study","OBJECTIVE: Meta-analyses show that exercise interventions during cancer treatment reduce cancer-related fatigue. However, little is known about the cost-effectiveness of such interventions. Here we aim to assess the cost-effectiveness of the 18-week physical activity during cancer treatment (PACT) intervention for patients with breast and colon cancer. The PACT trial showed beneficial effects for fatigue and physical fitness. DESIGN: Cost-effectiveness analyses with a 9-month time horizon (18 weeks of intervention and 18 weeks of follow-up) within the randomised controlled multicentre PACT study. SETTING: Outpatient clinics of 7 hospitals in the Netherlands (1 academic and 6 general hospitals) PARTICIPANTS: 204 patients with breast cancer and 33 with colon cancer undergoing adjuvant treatment including chemotherapy. INTERVENTION: Supervised 1-hour aerobic and resistance exercise (twice per week for 18 weeks) or usual care. MAIN OUTCOME MEASURES: Costs, quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio. RESULTS: For colon cancer, the cost-effectiveness analysis showed beneficial effects of the exercise intervention with incremental costs savings of euro4321 and QALY improvements of 0.03. 100% of bootstrap simulations indicated that the intervention is dominant (ie, cheaper and more effective). For breast cancer, the results did not indicate that the exercise intervention was cost-effective. Incremental costs were euro2912, and the incremental effect was 0.01 QALY. At a Dutch threshold value of euro20 000 per QALY, the probability that the intervention is cost-effective was 2%. CONCLUSIONS: Our results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer. TRIAL REGISTRATION NUMBER: ISRCTN43801571.","BMJ Open 7(Number): e012187","Netherlands",2017,"Cancer,Cancer","Physiotherapy",null,"Unspecified","CUA","RCT"]
[56,"McKinnon, R. A., et al. (2016). \"Obesity-Related Policy/Environmental Interventions: A Systematic Review of Economic Analyses.\" Am J Prev Med 50(4): 543-549.",null,"McKinnon, R. A., et al.","Obesity-Related Policy/Environmental Interventions: A Systematic Review of Economic Analyses","CONTEXT: Policy and environmental changes to support and encourage individual-level nutrition and physical activity behavior are underway in many parts of the U.S. and around the world at national, state, and local levels. Yet, to the authors' knowledge, no summary of the cost-benefit or cost-effectiveness studies of obesity-related policy/environmental interventions exists. EVIDENCE ACQUISITION: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines were followed to identify, screen, and describe the protocols used in this systematic review. In 2014, a unique search was conducted of titles and abstracts in MEDLINE, EconLit, SCOPUS, and Web of Science databases that were published from January 2002 through January 2014 in English-language, peer-reviewed journals. The search terms described obesity, physical activity, and diet in combination with economic evaluation. EVIDENCE SYNTHESIS: In 2014 and 2015, the results were analyzed. A total of 27 studies met the inclusion criteria, of which 26 described separate interventions. Of the 27 included studies, eight focused on the community and built environment, seven assessed nutrition-related changes, nine reported on the school environment, and three evaluated social marketing and media interventions. The vast majority of included studies reported beneficial economic outcomes of the interventions. CONCLUSIONS: Given the large and growing literature on the health and behavioral outcomes of policy and environmental interventions, the relatively low number of located cost-benefit and cost-effectiveness economic assessments appears to indicate a prime opportunity for the research community to address.","Am J Prev Med 50(Number): 543-549","International",2016,"Various","Unspecified",null,"Unspecified","CEA,CUA,CBA","SLR"]
[57,"McLean, K., et al. (2015). \"Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population.\" BMC Geriatr 15: 33.",null,"McLean, K., et al.","Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population","BACKGROUND: Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population. METHODS: A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP). RESULTS: The ICER of GBP pound51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP pound20,000 to pound30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP pound25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP pound99,664 per QALY and GBP pound50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP pound22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP pound48,212 in the women only base case analysis and GBP pound23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP pound652 (GBP pound616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even. CONCLUSIONS: The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.","BMC Geriatr 15(Number): 33","UK",2015,"None","Home Based Training",null,"Elderly","CUA","RCT"]
[58,"McRobbie, H., et al. (2016). \"Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme - a randomised controlled trial and economic evaluation.\" Health Technol Assess 20(79): 1-150.",null,"McRobbie, H., et al.","Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme - a randomised controlled trial and economic evaluation","BACKGROUND: An increasing number of people require help to manage their weight. The NHS recommends weight loss advice by general practitioners and/or a referral to a practice nurse. Although this is helpful for some, more effective approaches that can be disseminated economically on a large scale are needed. OBJECTIVE: To assess whether or not a task-based weight management programme [Weight Action Programme (WAP)] has better long-term effects than a 'best practice' intervention provided in primary care by practice nurses. DESIGN: Randomised controlled trial with cost-effectiveness analysis. SETTING: General practices in east London, UK. PARTICIPANTS: Three hundred and thirty adults with a body mass index (BMI) of >/= 30 kg/m(2) or a BMI of >/= 28 kg/m(2) plus comorbidities were recruited from local general practices and via media publicity. Those who had a BMI of > 45 kg/m(2), had lost > 5% of their body weight in the previous 6 months, were currently pregnant or taking psychiatric medications were excluded. Participants were randomised (2 : 1) to the WAP or nurse arms. INTERVENTIONS: The WAP intervention was delivered in eight weekly group sessions that combined dietary and physical activity, advice and self-monitoring in a group-oriented intervention. The initial course was followed by 10 monthly group maintenance sessions open to all participants in this study arm. The practice nurse intervention (best usual care) consisted of four one-to-one sessions delivered over 8 weeks, and included standard advice on diet and physical activity based on NHS 'Change4Life' materials and motivational support. MAIN OUTCOME MEASURES: The primary outcome measure was weight change at 12 months. Secondary outcome measures included change in BMI, waist circumference and blood pressure, and proportion of participants losing at least 5% and 10% of baseline body weight. Staff collecting measurements at the 6- and 12-month follow-ups were blinded to treatment allocation. The primary outcome measure was analysed according to the intention-to-treat principle, and included all participants with at least one recorded outcome at either 1, 2, 6 or 12 months. The analysis employed a mixed-effects linear regression model, adjusted for baseline weight, age, sex, ethnicity, smoking status and general practice. The European Quality of Life-5 Dimensions-5 Levels questionnaire was completed and used to estimate quality-adjusted life-years (QALYs) within the cost-effectiveness analysis. RESULTS: There were 330 participants (WAP arm, n = 221; nurse arm, n = 109; 72% women). A total of 291 (88%) participants (WAP arm, n = 194; nurse arm, n = 97) were included in the main analysis for the primary outcome. Weight loss at 12 months was greater in the WAP arm than in the nurse intervention arm [-4.2 kg vs. -2.3 kg; difference -1.9 kg, 95% confidence interval (CI) -3.7 to -0.1 kg; p = 0.04]. Participants in the WAP arm were more likely than participants in the nurse arm to have lost at least 5% of their baseline body weight at 12 months (41% vs. 27%; odds ratio 14.61, 95% CI 2.32 to 91.96; p = 0.004). The incremental cost-effectiveness ratio for WAP over and above the nurse arm is pound7742 per QALY. CONCLUSIONS: A WAP delivered in general practice better promotes weight loss over 12 months than a best usual practice nurse-led weight loss programme. LIMITATIONS: The trial recruited mostly women. Research is needed into factors that would make weight loss programmes more attractive to men. TRIAL REGISTRATION: Current Controlled Trials ISRCTN45820471. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 79. See the NIHR Journals Library website for further project information.","Health Technol Assess 20(Number): 1-150","UK",2016,"Various","Unspecified",null,"Any","CUA","RCT"]
[59,"Mewes, J. C., et al. (2017). \"Value of Implementation of Strategies to Increase the Adherence of Health Professionals and Cancer Survivors to Guideline-Based Physical Exercise.\" Value Health 20(10): 1336-1344.",null,"Mewes, J. C., et al.","Value of Implementation of Strategies to Increase the Adherence of Health Professionals and Cancer Survivors to Guideline-Based Physical Exercise","BACKGROUND: To increase the adherence of health professionals and cancer survivors to evidence-based physical exercise, effective implementation strategies (ISTs) are required. OBJECTIVES: To examine to what extent these ISTs provide value for money and which IST has the highest expected value. METHODS: The net benefit framework of health economic evaluations is used to conduct a value-of-implementation analysis of nine ISTs. Seven are directed to health professionals and two to cancer survivors. The analysis consists of four steps: 1) analyzing the expected value of perfect implementation (EVPIM); 2) assessing the estimated costs of the various ISTs; 3) comparing the ISTs' costs with the EVPIM; and 4) assessing the total net benefit (TNB) of the ISTs. These steps are followed to identify which strategy has the greatest value. RESULTS: The EVPIM for physical exercise in the Netherlands is euro293 million. The total costs for the ISTs range from euro34,000 for printed educational materials for professionals to euro120 million for financial incentives for patients, and thus all are cost-effective. The TNB of the ISTs that are directed to professionals ranges from euro5.7 million for printed educational materials to euro30.9 million for reminder systems. Of the strategies that are directed to patients, only the motivational program had a positive net benefit of euro100.4 million. CONCLUSIONS: All the ISTs for cancer survivors, except for financial incentives, had a positive TNB. The largest improvements in adherence were created by a motivational program for patients, followed by a reminder system for professionals.","Value Health 20(Number): 1336-1344","Netherlands",2017,"Cancer","Unspecified",null,"Unspecified","CBA","SLR"]
[60,"Milte, R., et al. (2016). \"Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture.\" J Rehabil Med 48(4): 378-385.",null,"Milte, R., et al.","Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture","OBJECTIVE: To undertake a cost-utility analysis of the Individual Nutrition Therapy and Exercise Regime: A Controlled Trial of Injured, Vulnerable Elderly (INTERACTIVE) trial. DESIGN: Cost-utility analysis of a randomized controlled trial. SUBJECTS: A total of 175 patients following a hip fracture were allocated to receive either alternate weekly visits from a physical therapist and dietitian (intervention group), or social visits for 6 months (control group). METHODS: Costs for utilization of hospitals, health and community services were compared with quality-adjusted life years gained, calculated from responses to the Assessment of Quality of Life instrument. RESULTS: There were minimal differences in mean costs between the intervention ($AUD 45,331 standard deviation (SD): $AUD 23,012) and the control group ($AUD 44,764 SD: $AUD 20,712, p = 0.868), but a slightly higher mean gain in quality-adjusted life years in the intervention group (0.155, SD: 0.132) compared with the control group (0.139, SD: 0.149, p = 0.470). The incremental cost-effectiveness ratio was $AUD 28,350 per quality-adjusted life year gained, which is below the implied cost-effectiveness threshold utilized by regulatory authorities in Australia. CONCLUSION: A comprehensive 6-month programme of therapy from dietitians and physical therapists could be provided at a relatively low additional cost in this group of frail older adults, and the incremental cost-effectiveness ratio indicates likely cost-effectiveness, although there was a very high level of uncertainty in the findings.","J Rehabil Med 48(Number): 378-385","Australia",2016,"Musculoskeletal","Physiotherapy",null,"Elderly","CUA","RCT"]
[61,"Moore, J. B., et al. (2017). \"Cost-effectiveness of Community-Based Minigrants to Increase Physical Activity in Youth.\" J Public Health Manag Pract 23(4): 364-369.",null,"Moore, J. B., et al.","Cost-effectiveness of Community-Based Minigrants to Increase Physical Activity in Youth","CONTEXT: American youth are insufficiently active, and minigrant programs have been developed to facilitate implementation of evidence-based interventions in communities. However, little is known about the cost-effectiveness of targeted minigrant programs for the implementation of physical activity (PA) promoting strategies for youth. OBJECTIVE: To determine the cost-effectiveness of a minigrant program to increase PA among youth. DESIGN: Twenty community grantees were pair-matched and randomized to receive funding at the beginning of year 1 (2010-2011) or year 2 (2011-2012) to implement interventions to increase PA in youth. Costs were calculated by examining financial reports provided by the granting organization and grantees. SETTING: Twenty counties in North Carolina. PARTICIPANTS: A random sample of approximately 800 fourth- to eighth-grade youth (per year) from the approximately 6100 youth served by the 20 community-based interventions. MAIN OUTCOME MEASURE: Cost-effectiveness ratios (CERs) were calculated at the county and project levels to determine the cost per child-minute of moderate-to-vigorous PA (MVPA) increased by wave. Analyses were conducted utilizing cost data from 20 community grantees and accelerometer-derived PA from the participating youth. RESULTS: Of the 20 participating counties, 18 counties displayed increased youth MVPA between at least 2 waves of observation. Of those 18 counties, the CER (US dollars/MVPA minutes per day) ranged from $0.02 to $1.86 (n = 13) in intervention year 1, $0.02 to $6.19 (n = 15) in intervention year 2, and $0.02 to $0.58 (n = 17) across both years. CONCLUSION: If utilized to implement effectual behavior change strategies, minigrants can be a cost-effective means of increasing children's MVPA, with a low monetary cost per minute of MVPA.","J Public Health Manag Pract 23(Number): 364-369","USA",2017,"None","Unspecified",null,"Children,Adolescents","CEA","RCT"]
[62,"Mori, T., et al. (2017). \"Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA.\" Osteoporos Int 28(2): 585-595.",null,"Mori, T., et al.","Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA","We developed a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women without prior major osteoporotic fractures over a lifetime horizon. At ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a conventionally accepted threshold compared with bisphosphonates alone. INTRODUCTION: The purpose of this study was to examine the cost-effectiveness of the combined strategy of oral bisphosphonate therapy for 5 years and falls prevention exercise for 1 year compared with either strategy in isolation. METHODS: We calculated incremental cost-effectiveness ratios [ICERs] (2014 US dollars per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women with different starting ages (65, 70, 75, and 80) without prior history of hip, vertebral, or wrist fractures over a lifetime horizon from the societal perspective. RESULTS: At ages 65, 70, 75, and 80, the combined strategy had ICERs of $202,020, $118,460, $46,870, and $17,640 per QALY, respectively, compared with oral bisphosphonate therapy alone. The combined strategy provided better health at lower cost than falls prevention exercise alone at ages 70, 75, and 80. In deterministic sensitivity analyses, results were particularly sensitive to the change in the opportunity cost of participants' time spent exercising. In probabilistic sensitivity analyses, the probabilities of the combined strategy being cost-effective compared with the next best alternative increased with age, ranging from 35 % at age 65 to 48 % at age 80 at a willingness-to-pay of $100,000 per QALY. CONCLUSIONS: Among community-dwelling US white women ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a willingness-to-pay of $100,000 per QALY, compared with oral bisphosphonate therapy only. This analysis will help clinicians and policymakers make better decisions about treatment options to reduce fracture risk.","Osteoporos Int 28(Number): 585-595","USA",2017,"Various","Home Based Training",null,"Elderly","CUA","Cohort"]
[63,"Mueller, N., et al. (2015). \"Health impact assessment of active transportation: A systematic review.\" Prev Med 76: 103-114.",null,"Mueller, N., et al.","Health impact assessment of active transportation: A systematic review","OBJECTIVE: Walking and cycling for transportation (i.e. active transportation, AT), provide substantial health benefits from increased physical activity (PA). However, risks of injury from exposure to motorized traffic and their emissions (i.e. air pollution) exist. The objective was to systematically review studies conducting health impact assessment (HIA) of a mode shift to AT on grounds of associated health benefits and risks. METHODS: Systematic database searches of MEDLINE, Web of Science and Transportation Research International Documentation were performed by two independent researchers, augmented by bibliographic review, internet searches and expert consultation to identify peer-reviewed studies from inception to December 2014. RESULTS: Thirty studies were included, originating predominantly from Europe, but also the United States, Australia and New Zealand. They compromised of mostly HIA approaches of comparative risk assessment and cost-benefit analysis. Estimated health benefit-risk or benefit-cost ratios of a mode shift to AT ranged between -2 and 360 (median=9). Effects of increased PA contributed the most to estimated health benefits, which strongly outweighed detrimental effects of traffic incidents and air pollution exposure on health. CONCLUSION: Despite different HIA methodologies being applied with distinctive assumptions on key parameters, AT can provide substantial net health benefits, irrespective of geographical context.","Prev Med 76(Number): 103-114","International",2015,"None","Walking,Cycling",null,"Any","CBA","SLR"]
[64,"Neumann, A., et al. (2017). \"The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program.\" Eur J Health Econ 18(7): 905-919.",null,"Neumann, A., et al.","The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program","BACKGROUND: Policymakers need to know the cost-effectiveness of interventions to prevent type 2 diabetes (T2D). The objective of this study was to estimate the cost-effectiveness of a T2D prevention initiative targeting weight reduction, increased physical activity and healthier diet in persons in pre-diabetic states by comparing a hypothetical intervention versus no intervention in a Swedish setting. METHODS: A Markov model was used to study the cost-effectiveness of a T2D prevention program based on lifestyle change versus a control group where no prevention was applied. Analyses were done deterministically and probabilistically based on Monte Carlo simulation for six different scenarios defined by sex and age groups (30, 50, 70 years). Cost and quality adjusted life year (QALY) differences between no intervention and intervention and incremental cost-effectiveness ratios (ICERs) were estimated and visualized in cost-effectiveness planes (CE planes) and cost-effectiveness acceptability curves (CEA curves). RESULTS: All ICERs were cost-effective and ranged from 3833 euro/QALY gained (women, 30 years) to 9215 euro/QALY gained (men, 70 years). The CEA curves showed that the probability of the intervention being cost-effective at the threshold value of 50,000 euro per QALY gained was very high for all scenarios ranging from 85.0 to 91.1%. DISCUSSION/CONCLUSION: The prevention or the delay of the onset of T2D is feasible and cost-effective. A small investment in healthy lifestyle with change in physical activity and diet together with weight loss are very likely to be cost-effective.","Eur J Health Econ 18(Number): 905-919","Sweden",2017,"None","Unspecified",null,"Adults,Elderly","CUA","RCT"]
[65,"Neumann, P. J., et al. (2016). \"Lack of Cost-Effectiveness Analyses to Address Healthy People 2020 Priority Areas.\" Am J Public Health 106(12): 2205-2207.",null,"Neumann, P. J., et al.","Lack of Cost-Effectiveness Analyses to Address Healthy People 2020 Priority Areas","OBJECTIVES: To examine the extent to which recently published cost-utility analyses (cost-effectiveness analyses using quality-adjusted life-years to measure health benefits) have covered the leading health concerns in the US Department of Health and Human Services Healthy People 2020 report. METHODS: We examined data in the Tufts Medical Center Cost-Effectiveness Analysis Registry, a database containing 5000 published cost-utility analyses published in the MEDLINE literature through 2014. We focused on US-based cost-utility analyses published from 2011 through 2014 (n = 687). Two reviewers scanned abstracts and met for a consensus on categorization of cost-utility analyses that addressed the specific priorities listed in the 12 Healthy People 2020 areas (n = 120). RESULTS: Although 7.3% of recently published cost-utility analyses addressed key clinical preventive services, only about 2% of recently published cost-utility analyses covered each of the following Healthy People 2020 topics: reproductive and sexual health, nutrition/physical activity/obesity, maternal and infant health, and tobacco. Fewer than 1% addressed priorities such as injuries and violence, mental health or substance abuse, environmental quality, and oral health. CONCLUSIONS: Few cost-utility analyses have addressed Healthy People 2020 priority areas.","Am J Public Health 106(Number): 2205-2207","International",2016,"None","Unspecified",null,"Unspecified","CUA","SLR"]
[66,"Oppong, R., et al. (2015). \"Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials.\" Rheumatology (Oxford) 54(5): 876-883.",null,"Oppong, R., et al.","Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials","OBJECTIVES: Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand OA is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytical methodologies. METHODS: A trial-based economic evaluation to assess the cost-utility of joint protection only, hand exercises only and joint protection plus hand exercises compared with leaflet and advice was undertaken over a 12 month period from a UK National Health Service perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves were constructed. The base case analysis used a within-the-table analysis methodology. Two further methods were explored: the at-the-margins approach and a regression-based approach with or without an interaction term. RESULTS: Mean costs (QALYs) were pound58.46 (s.d. 0.662) for leaflet and advice, pound92.12 (s.d. 0.659) for joint protection, pound64.51 (s.d. 0.681) for hand exercises and pound112.38 (s.d. 0.658) for joint protection plus hand exercises. In the base case, hand exercises were the cost-effective option, with an ICER of pound318 per QALY gained. Hand exercises remained the most cost-effective management strategy when adopting alternative methodological approaches. CONCLUSION: This is the first trial evaluating the cost-effectiveness of occupational therapy-supported approaches to self-management for hand OA. Our findings showed that hand exercises were the most cost-effective option.","Rheumatology (Oxford) 54(Number): 876-883","UK",2015,"Musculoskeletal","Unspecified",null,"Unspecified","CUA","RCT"]
[67,"Panman, C. M., et al. (2016). \"Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care.\" Menopause 23(12): 1307-1318.",null,"Panman, C. M., et al.","Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care","OBJECTIVE: We investigated the effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training (PFMT) in women with pelvic organ prolapse over a 2-year period. METHODS: Randomized controlled trial with women (>/=55 y) with symptomatic pelvic organ prolapse, identified by screening. Participants were recruited from 20 primary care practices (October 2009-December 2012). Primary outcome was the difference in change of pelvic floor symptoms (PFDI-20 score) between groups over 24 months. Secondary outcomes included prolapse, urinary, and anorectal symptoms; quality of life; costs; sexual functioning; prolapse stage; pelvic floor muscle function; and participants' perceived symptom improvement. RESULTS: There was a nonsignificant difference in the primary outcome between pessary treatment (n = 82) and PFMT (n = 80) with a mean difference of -3.7 points (95% CI, -12.8 to 5.3; P = 0.42) in favor of pessary treatment. A significantly greater improvement in the prolapse symptom score was, however, seen with pessary treatment (mean difference -3.2 points [95% CI, -6.3 to -0.0; P = 0.05]). Direct medical costs over the 2-year study were $309 and $437 per person for pessary treatment and PFMT, respectively. CONCLUSIONS: In older women with symptomatic prolapse, there was no significant difference between pessary treatment and PFMT in reducing pelvic floor symptoms, but specific prolapse-related symptoms did improve more with pessary treatment. Pessary treatment was preferable in the cost-effectiveness analysis. When counseling women for prolapse treatment it should, however, be taken into account that pessary fitting fails in a considerable portion of women and that pessary treatment was associated with more side effects compared with PFMT.","Menopause 23(Number): 1307-1318","Unclear",2016,"Various","Home Based Training",null,"Unspecified","CEA","RCT"]
[68,"Patil, R., et al. (2016). \"Cost-effectiveness of vitamin D supplementation and exercise in preventing injurious falls among older home-dwelling women: findings from an RCT.\" Osteoporos Int 27(1): 193-201.",null,"Patil, R., et al.","Cost-effectiveness of vitamin D supplementation and exercise in preventing injurious falls among older home-dwelling women: findings from an RCT","UNLABELLED: This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older home-dwelling Finnish women. Given a willingness to pay of euro3,000 per injurious fall prevented, the exercise intervention had an 86 % probability of being cost-effective in this population. INTRODUCTION: The costs of falling in older persons are high, both to the individual and to society. Both vitamin D and exercise have been suggested to reduce the risk of falls. This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older Finnish women. METHODS: Economic evaluation was based on the results of a previously published 2-year randomized controlled trial (RCT) where 409 community-dwelling women aged 70 to 80 years were recruited into four groups: (1) no exercise + placebo (D-Ex-), (2) no exercise + vitamin D 800 IU/day (D+Ex-), (3) exercise + placebo (D-Ex+), and (4) exercise + vitamin D 800 IU/day (D+Ex+). The outcomes were medically attended injurious falls and fall-related health care utilization costs over the intervention period, the latter evaluated from a societal perspective based on 2011 unit costs. Incremental cost-effectiveness ratios (ICER) were calculated for the number of injurious falls per person-year prevented and uncertainty estimated using bootstrapping. RESULTS: Incidence rate ratios (95 % CI) for medically attended injurious falls were lower in both Ex+ groups compared with D-Ex-: 0.46 (0.22 to 0.95) for D-Ex+, 0.38 (0.17 to 0.81) for D+Ex+. Step-wise calculation of ICERs resulted in exclusion of D+Ex- as more expensive and less effective. Recalculated ICERs were euro221 for D-Ex-, euro708 for D-Ex+, and euro3,820 for D+Ex+; bootstrapping indicated 93 % probability that each injurious fall avoided by D-Ex+ per person year costs euro708. At a willingness to pay euro3,000 per injurious fall prevented, there was an 85.6 % chance of the exercise intervention being cost-effective in this population. CONCLUSIONS: Exercise was effective in reducing fall-related injuries among community-dwelling older women at a moderate cost. Vitamin D supplementation had marginal additional benefit. The results provide a firm basis for initiating feasible and cost-effective exercise interventions in this population.","Osteoporos Int 27(Number): 193-201","Finland",2016,"Various","Home Based Training",null,"Elderly","CEA","RCT"]
[69,"Priebe, S., et al. (2016). \"Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial.\" Health Technol Assess 20(11): vii-xxiii, 1-100.",null,"Priebe, S., et al.","Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial","BACKGROUND: The negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control. DESIGN: A parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted. PARTICIPANTS: ELIGIBILITY CRITERIA: age 18-65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of >/= 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient. EXCLUSION CRITERIA: inability to participate in the groups and insufficient command of English. SETTINGS: Participants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces. INTERVENTIONS: Control intervention: a 10-week, 90-minute, 20-session group beginners' Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist. OUTCOMES: The primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up. RESULTS: A total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in means of the PANSS negative subscale at the end of treatment was 0.03 [95% confidence interval (CI) -1.11 to 1.17], showing no advantage of the intervention. In the secondary outcomes, the mean difference in the Clinical Assessment Interview for negative symptoms expression subscale at the end of treatment was 0.62 (95% CI -1.23 to 0.00), and in extrapyramidal movement disorder symptoms -0.65 (95% CI -1.13 to -0.16) at the end of treatment and -0.58 (95% CI -1.07 to -0.09) at 6 months' follow-up, showing a small significant advantage of body psychotherapy. No serious adverse events related to the interventions were reported. The total costs of the intervention were comparable with the control, with no clear evidence of cost-effectiveness for either condition. LIMITATIONS: Owing to the absence of a treatment-as-usual arm, it is difficult to determine whether or not both arms are an improvement over routine care. CONCLUSIONS: In comparison with an active control, group body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia. These findings conflict with the review that led to the current National Institute for Health and Care Excellence guidelines suggesting that arts therapies may be an effective treatment for negative symptoms. FUTURE WORK: Determining whether or not this lack of effectiveness extends to all types of art therapies would be informative. TRIAL REGISTRATION: Current Controlled Trials ISRCTN842165587. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 11. See the NIHR Journals Library website for further project information.","Health Technol Assess 20(Number): vii-xxiii, 1-100","UK",2016,"Mental Illness","Dance",null,"Adults","CEA","RCT"]
[70,"Rincon, M., et al. (2016). \"Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia.\" J Cardiopulm Rehabil Prev 36(1): 12-19.",null,"Rincon, M., et al.","Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia","PURPOSE: Cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) has met with resistance from third-party payers in low- and middle-income countries because of lack of evidence regarding its cost-effectiveness. We aimed to provide information to help better inform this decision-making process. METHODS: Costs associated with a 12-week exercise-based rehabilitation program in Colombia for patients with CHF were estimated. We collected data on all medical resources used in ambulatory care and data on hospital costs incurred for treating patients with uncompensated CHF. A literature search to establish the hospitalization rates because of uncompensated CHF, death because of CHF, and potential decreases in these data because of the utilization of CR was conducted. We modeled incremental costs and effectiveness over a period of 5 years from the perspective of the third-party payer. RESULTS: All costs were converted from Colombian pesos to US dollars. For an exercise-based CR program of 12-week duration (36 sessions), costs ranged from US$265 to US$369 per patient. Monthly costs associated with ambulatory care of CHF averaged US$128 +/- US$321 per patient, and hospitalization costs were US$3621 +/- US$5 444 per event. Yearly hospitalization incidence rates with and without CR were 0.154 and 0.216, respectively. The incremental cost of CR would be US$998 per additional quality-adjusted life-year. Sensitivity analysis did not significantly change these results. CONCLUSIONS: Cardiac rehabilitation in patients with CHF in settings such as Colombia can be a cost-effective strategy, with minimal incremental costs and better quality of life, mainly because of decreased rates of hospitalization.","J Cardiopulm Rehabil Prev 36(Number): 12-19","Colombia",2016,"Cardiovascular","Unspecified",null,"Unspecified","CUA","Cohort"]
[71,"Robertson, W., et al. (2017). \"Randomised controlled trial and economic evaluation of the 'Families for Health' programme to reduce obesity in children.\" Arch Dis Child 102(5): 416-426.",null,"Robertson, W., et al.","Randomised controlled trial and economic evaluation of the 'Families for Health' programme to reduce obesity in children","OBJECTIVE: Evaluating effectiveness and cost-effectiveness of 'Families for Health V2' (FFH) compared with usual care (UC). DESIGN: Multicentre randomised controlled trial (RCT) (investigators blinded, families unblinded) and economic evaluation. Stratified randomisation by family; target of 120 families. SETTING: Three National Health Service Primary Care Trusts in West Midlands, England. PARTICIPANTS: Overweight or obese (>/=91st or >/=98th centile body mass index (BMI)) children aged 6-11 years and their parents/carers, recruited March 2012-February 2014. INTERVENTIONS: FFH; a 10-week community-based family programme addressing parenting, lifestyle change and social and emotional development. UC; usual support for childhood obesity at each site. MAIN OUTCOME MEASURES: Primary outcomes were 12-months change in children's BMI z-score and incremental cost per quality-adjusted life-year gained (QALY). Secondary outcomes included changes in children's physical activity, fruit and vegetable consumption and quality of life, parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style. RESULTS: 115 families (128 children) were randomised to FFH (n=56) or UC (n=59). There was no significant difference in BMI z-score 12-months change (0.114, 95% CI -0.001 to 0.229, p=0.053; p=0.026 in favour of UC with missing value multiple imputation). One secondary outcome, change in children's waist z-score, was significantly different between groups in favour of UC (0.15, 95% CI 0.00 to 0.29). Economic evaluation showed that mean costs were significantly higher for FFH than UC ( pound998 vs pound548, p<0.001). Mean incremental cost-effectiveness of FFH was estimated at pound552 175 per QALY. CONCLUSIONS: FFH was neither effective nor cost-effective for the management of obesity compared with UC. TRIAL REGISTRATION NUMBER: ISRCTN45032201.","Arch Dis Child 102(Number): 416-426","UK",2017,"Various","Unspecified",null,"Children","CUA","RCT"]
[72,"Robertson, W., et al. (2017). \"Randomised controlled trial evaluating the effectiveness and cost-effectiveness of 'Families for Health', a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years.\" Health Technol Assess 21(1): 1-180.",null,"Robertson, W., et al.","Randomised controlled trial evaluating the effectiveness and cost-effectiveness of 'Families for Health', a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years","BACKGROUND: Effective programmes to help children manage their weight are required. 'Families for Health' focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health version 1 showed sustained reductions in mean body mass index (BMI) z-score after 2 years in a pilot project. OBJECTIVE: The aim was to evaluate its effectiveness and cost-effectiveness in a randomised controlled trial (RCT). DESIGN: The trial was a multicentre, investigator-blind RCT, with a parallel economic and process evaluation, with follow-up at 3 and 12 months. Randomisation was by family unit, using a 1 : 1 allocation by telephone registration, stratified by three sites, with a target of 120 families. SETTING: Three sites in the West Midlands, England, UK. PARTICIPANTS: Children aged 6-11 years who were overweight (>/= 91st centile BMI) or obese (>/= 98th centile BMI), and their parents/carers. Recruitment was via referral or self-referral. INTERVENTIONS: Families for Health version 2 is a 10-week, family-based community programme with parallel groups for parents and children, addressing parenting, lifestyle, social and emotional development. Usual care was the treatment for childhood obesity provided within each locality. MAIN OUTCOME MEASURES: Joint primary outcome measures were change in children's BMI z-score and incremental cost per quality-adjusted life-year (QALY) gained at 12 months' follow-up (QALYs were calculated using the European Quality of Life-5 Dimensions Youth version). Secondary outcome measures included changes in children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. Parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style were also assessed. The process evaluation documented recruitment, reach, dose delivered, dose received and fidelity, using mixed methods. RESULTS: The study recruited 115 families (128 children; 63 boys and 65 girls), with 56 families randomised to the Families for Health arm and 59 to the 'usual-care' control arm. There was 80% retention of families at 3 months (Families for Health, 46 families; usual care, 46 families) and 72% retention at 12 months (Families for Health, 44 families; usual care, 39 families). The change in BMI z-score at 12 months was not significantly different in the Families for Health arm and the usual-care arm [0.114, 95% confidence interval (CI) -0.001 to 0.229; p = 0.053]. However, within-group analysis showed that the BMI z-score was significantly reduced in the usual-care arm (-0.118, 95% CI -0.203 to -0.034; p = 0.007), but not in the Families for Health arm (-0.005, 95% CI -0.085 to 0.078; p = 0.907). There was only one significant difference between groups for secondary outcomes. The economic evaluation, taking a NHS and Personal Social Services perspective, showed that mean costs 12 months post randomisation were significantly higher for Families for Health than for usual care ( pound998 vs. pound548; p < 0.001). The mean incremental cost-effectiveness of Families for Health was estimated at pound552,175 per QALY gained. The probability that the Families for Health programme is cost-effective did not exceed 40% across a range of thresholds. The process evaluation demonstrated that the programme was implemented, as planned, to the intended population and any adjustments did not deviate widely from the handbook. Many families waited more than 3 months to receive the intervention. Facilitators', parents' and children's experiences of Families for Health were largely positive and there were no adverse events. Further analysis could explore why some children show a clinically significant benefit while others have a worse outcome. CONCLUSIONS: Families for Health was neither effective nor cost-effective for the management of obesity in children aged 6-11 years, in comparison with usual care. Further exploration of the wide range of responses in BMI z-score in children following the Families for Health and usual-care interventions is warranted, focusing on children who had a clinically significant benefit and those who showed a worse outcome with treatment. Further research could focus on the role of parents in the prevention of obesity, rather than treatment. TRIAL REGISTRATION: Current Controlled Trials ISRCTN45032201. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 1. See the NIHR Journals Library website for further project information.","Health Technol Assess 21(Number): 1-180","UK",2017,"Various","Unspecified",null,"Children","CUA","RCT"]
[73,"Roux, L., et al. (2015). \"Does age modify the cost-effectiveness of community-based physical activity interventions?\" J Phys Act Health 12(2): 224-231.",null,"Roux, L., et al.","Does age modify the cost-effectiveness of community-based physical activity interventions?","BACKGROUND: Community-based efforts to promote physical activity (PA) in adults have been found to be cost-effective in general, but it is unknown if this is true in middle-age specifically. Age group-specific economic evaluations could help inform the design and delivery of better and more tailored PA promotion. METHODS: A Markov model was developed to estimate the cost-effectiveness (CE) of 7 exemplar community-level interventions to promote PA recommended by the Guide to Community Preventive Services, over a 20-year horizon. The CE of these interventions in 25- to 64-year-old adults was compared with their CE in middle-aged adults, aged 50 to 64 years. The robustness of the results was examined through sensitivity analyses. RESULTS: Cost/QALY (quality-adjusted life year) of the evaluated interventions in 25- to 64-year-olds ranged from $42,456/QALY to $145,868/QALY. Interventions were more cost-effective in middle-aged adults, with CE ratios 38% to 47% lower than in 25- to 64-year-old adults. Sensitivity analyses showed greater than a 90% probability that the true CE of 4 of the 7 interventions was below $125,000/QALY in adults aged 50 to 64 years. CONCLUSION: The exemplar PA promotion interventions evaluated appeared to be especially cost-effective for middle-aged adults. Prioritizing such efforts to this age group is a good use of societal resources.","J Phys Act Health 12(Number): 224-231","Unclear",2015,"Various","Unspecified",null,"Adults","CUA","Cohort"]
[74,"Rush, E., et al. (2016). \"Project Energize: intervention development and 10 years of progress in preventing childhood obesity.\" BMC Res Notes 9: 44.",null,"Rush, E., et al.","Project Energize: intervention development and 10 years of progress in preventing childhood obesity","Prevention of childhood obesity is a global priority. The school setting offers access to large numbers of children and the ability to provide supportive environments for quality physical activity and nutrition. This article describes Project Energize, a through-school physical activity and nutrition programme that celebrated its 10-year anniversary in 2015 so that it might serve as a model for similar practices, initiatives and policies elsewhere. The programme was envisaged and financed by the Waikato District Health Board of New Zealand in 2004 and delivered by Sport Waikato to 124 primary schools as a randomised controlled trial from 2005 to 2006. The programme has since expanded to include all 242 primary schools in the Waikato region and 70 schools in other regions, including 53,000 children. Ongoing evaluation and development of Project Energize has shown it to be sustainable (ongoing for >10 years), both effective (lower obesity, higher physical fitness) and cost effective (one health related cost quality adjusted life year between $18,000 and $30,000) and efficient ($45/child/year) as a childhood 'health' programme. The programme's unique community-based approach is inclusive of all children, serving a population that is 42% Maori, the indigenous people of New Zealand. While the original nine healthy eating and seven quality physical activity goals have not changed, the delivery and assessment processes has been refined and the health service adapted over the 10 years of the programme existence, as well as adapted over time to other settings including early childhood education and schools in Cork in Ireland. Evaluation and research associated with the programme delivery and outcomes are ongoing. The dissemination of findings to politicians and collaboration with other service providers are both regarded as priorities.","BMC Res Notes 9(Number): 44","New Zealand",2016,"Various","Unspecified",null,"Children","CUA","Narrative review"]
[75,"Sangster, J., et al. (2015). \"A comparison of the cost-effectiveness of two pedometer-based telephone coaching programs for people with cardiac disease.\" Heart Lung Circ 24(5): 471-479.",null,"Sangster, J., et al.","A comparison of the cost-effectiveness of two pedometer-based telephone coaching programs for people with cardiac disease","INTRODUCTION: Following a cardiac event it is recommended that cardiac patients participate in cardiac rehabilitation (CR) programs. However, little is known about the relative cost-effectiveness of lifestyle-related interventions for cardiac patients. This study aimed to compare the cost-effectiveness of a telephone-delivered Healthy Weight intervention to a telephone-delivered Physical Activity intervention for patients referred to CR in urban and rural Australia. METHODS: A cost-utility analysis was conducted alongside a randomised controlled trial of the two interventions. Outcomes were measured as Quality Adjusted Life Years (QALYs) gained. RESULTS: The estimated cost of delivering the interventions was $201.48 per Healthy Weight participant and $138.00 per Physical Activity participant. The average total cost (cost of health care utilisation plus patient costs) was $1,260 per Healthy Weight participant and $2,112 per Physical Activity participant, a difference of $852 in favour of the Healthy Weight intervention. Healthy Weight participants gained an average of 0.007 additional QALYs than did Physical Activity participants. Thus, overall the Healthy Weight intervention dominated the Physical Activity intervention (Healthy Weight intervention was less costly and more effective than the Physical Activity intervention). Subgroup analyses showed the Healthy Weight intervention also dominated the Physical Activity intervention for rural participants and for participants who did not attend CR. CONCLUSIONS: The low-contact pedometer-based telephone coaching Healthy Weight intervention is overall both less costly and more effective compared to the Physical Activity intervention, including for rural cardiac patients and patients that do not attend CR.","Heart Lung Circ 24(Number): 471-479","Australia",2015,"Cardiovascular","Unspecified",null,"Unspecified","CUA","RCT"]
[76,"Schasfoort, F., et al. (2018). \"Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study.\" J Rehabil Med 50(1): 22-29.",null,"Schasfoort, F., et al.","Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study","OBJECTIVE: Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. DESIGN: A pragmatically designed, multi-centre trial, comparing the effectiveness of botulinum toxin + intensive physiotherapy with intensive physiotherapy alone, including economic evaluation. SUBJECTS/PATIENTS: Children with spastic cerebral palsy, age range 4-12 years, cerebral palsy-severity Gross Motor Function Classification System levels I-III, received either botulinum toxin type A + intensive physiotherapy or intensive physiotherapy alone and, if necessary, ankle-foot orthoses and/or casting. METHODS: Primary outcomes were gross motor func-tion, physical activity levels, and health-related quality-of-life, assessed at baseline, 12 (primary end-point) and 24 weeks (follow-up). Economic outcomes included healthcare and patient costs. Intention-to-treat analyses were performed with linear mixed models. RESULTS: There were 65 participants (37 males), with a mean age of 7.3 years (standard deviation 2.3 years), equally distributed across Gross Motor Function Classification System levels. Forty-one children received botulinum toxin type A plus intensive physio-therapy and 24 received intensive physiotherapy treatment only. At primary end-point, one statistically significant difference was found in favour of intensive physiotherapy alone: objectively measured percentage of sedentary behaviour (-3.42, 95% confidence interval 0.20-6.64, p=0.038). Treatment costs were significantly higher for botulinum toxin type A plus intensive physiotherapy (8,963 vs 6,182 euro, p=0.001). No statistically significant differences were found between groups at follow-up. CONCLUSION: The addition of botulinum toxin type A to intensive physiotherapy did not improve the effectiveness of rehabilitation for ambulatory children with spastic cerebral palsy and was also not cost-effective. Thus botulinum toxin is not recommended for use in improving gross motor function, activity levels or health-related quality-of-life in this cerebral palsy age- and severity-subgroup.","J Rehabil Med 50(Number): 22-29","Unclear",2018,"Neuromuscular","Unspecified",null,"Children","CUA","RCT"]
[77,"Shephard, R. J. (2016). \"Sickle cell trait: what are the costs and benefits of screening?\" J Sports Med Phys Fitness 56(12): 1562-1573.",null,"Shephard, R. J.","Sickle cell trait: what are the costs and benefits of screening?","INTRODUCTION: Eight percent of African Americans are carriers of the sickle cell trait. Some regard this as a benign anomaly, but others point to incidents of sudden exercise-related death, calling for a preliminary screening of either all athletes or those of African-American ancestry. This brief review considers the costs and benefits of such screening. EVIDENCE ACQUISITION: The Ovid/Health Star data-base was searched from 1996 to June 2015. 2014. The terms \"exercise\", \"exercise therapy\", \"sports\", \"athletes\", \"physical activity/motor activity\" and \"physical fitness\" were combined to yield 227,120 citations. Likewise, the terms \"sickle cell trait\", \"sickle cell disease\", \"splenic infarction\", \"hemoglobin S\" and \"rhabdomyolysis\" identified 12,325 citations. A combination of the 2 searches yielded 416 abstracts. EVIDENCE SYNTHESIS: Excluding items relating to animal research or forms of rhabdomyolysis other than sickling left 375 abstracts; 115 papers merited full examination. This material covered the risks of sickle cell trait and of screening (55 items), effects upon physical performance (31 items), cellular mechanisms (23 items), nutrition (4 items), and other topics (2 items). Supplemented material was drawn from reference lists and personal files. The tendency to sickling was provoked by excessive exercise relative to physical condition in hot or hypoxic conditions, and by local tissue acidosis, conditions that were best avoided by all athletes. The condition had little impact upon physical performance, but the relative risks of heat illness, exertional rhabdomyolysis, splenic infarction and sudden death were all increased by the sickle cell trait. The absolute number of critical incidents was nevertheless small, calling for close assessment of the costs and putative benefits of widespread screening. CONCLUSIONS: Sports physicians should be aware of the clinical picture of sickling and be prepared to treat it. Screening may be cost-effective if targeted to black athletes involved in certain sports, although it has yet to be demonstrated how far the diagnosis of sickle cell trait reduces the risk of death when exercising in an adverse environment. A better tactic may be to reduce risks for all competitors by educating athletes and their coaches to adopt an intensity of training appropriate to the individual's physical condition, to maintain full hydration, and to avoid exposure to excessive heat and hypoxia.","J Sports Med Phys Fitness 56(Number): 1562-1573","International",2016,"Various","Multiple",null,"Unspecified","CBA","SLR"]
[78,"Simpson, S. A., et al. (2015). \"A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults.\" Health Technol Assess 19(50): v-vi, xix-xxv, 1-378.",null,"Simpson, S. A., et al.","A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults","BACKGROUND: Obesity has significant health and NHS cost implications. Relatively small reductions in weight have clinically important benefits, but long-term weight loss maintenance (WLM) is challenging. Behaviour change interventions have been identified as key for WLM. Motivation is crucial to supporting behaviour change, and motivational interviewing (MI) has been identified as a successful approach to changing health behaviours. The study was designed as an adequately powered, pragmatic randomised controlled trial (RCT); however, owing to recruitment issues, the study became a feasibility trial. OBJECTIVES: To assess recruitment, retention, feasibility, acceptability, compliance and delivery of a 12-month intervention to support WLM. Secondary objectives were to assess the impact of the intervention on body mass index (BMI) and other secondary outcomes. DESIGN: Three-arm individually randomised controlled trial comprising an intensive arm, a less intensive arm and a control arm. SETTING: Community setting in South Wales and the East Midlands. PARTICIPANTS: Individuals aged 18-70 years with a current or previous BMI of >/= 30 kg/m(2) who could provide evidence of at least 5% weight loss during the previous 12 months. INTERVENTION: Participants received individually tailored MI, which included planning and self-monitoring. The intensive arm received six face-to-face sessions followed by nine telephone sessions. The less intensive arm received two face-to-face sessions followed by two telephone sessions. The control arm received a leaflet advising them on healthy lifestyle. MAIN OUTCOME MEASURES: Feasibility outcomes included numbers recruited, retention and adherence. The primary effectiveness outcome was BMI at 12 months post randomisation. Secondary outcomes included waist circumference, waist-to-hip ratio, physical activity, proportion maintaining weight loss, diet, quality of life, health service resource usage, binge eating and well-being. A process evaluation assessed intervention delivery, adherence, and participants' and practitioners' views. Economic analysis aimed to assess cost-effectiveness in terms of quality-adjusted life-years (QALYs). RESULTS: A total of 170 participants were randomised. Retention was good (84%) and adherence was excellent (intensive, 83%; less intensive, 91%). The between-group difference in mean BMI indicated the intensive arm had BMIs 1.0 kg/m(2) lower than the controls [95% confidence interval (CI) -2.2 kg/m(2) to 0.2 kg/m(2)]. Similarly, a potential difference was found in weight (average difference of 2.8 kg, 95% CI -6.1 kg to 0.5 kg). The intensive arm had odds of maintaining on average 43% [odds ratio(OR) 1.4, 95% CI 0.6 to 3.5] higher than controls. None of these findings were statistically significant. Further analyses controlling for level of adherence indicated that average BMI was 1.2 kg/m(2) lower in the intensive arm than the control arm (95% CI -2.5 kg/m(2) to 0.0 kg/m(2)). The intensive intervention led to a statistically significant difference in weight (mean -3.7 kg, 95% CI -7.1 kg to -0.3 kg). The other secondary outcomes showed limited evidence of differences between groups. The intervention was delivered as planned, and both practitioners and participants were positive about the intervention and its impact. Although not powered to assess cost-effectiveness, results of this feasibility study suggest that neither intervention as currently delivered is likely to be cost-effective in routine practice. CONCLUSION: This is the first trial of an intervention for WLM in the UK, the intervention is feasible and acceptable, and retention and adherence were high. The main effectiveness outcome showed a promising mean difference in the intensive arm. Owing to the small sample size, we are limited in the conclusions we can draw. However, findings suggest that the intensive intervention may facilitate long-term weight maintenance and, therefore, further testing in an effectiveness trial may be indicated. Research examining WLM is in its infancy, further research is needed to develop our understanding of WLM and to expand theory to inform the development of interventions to be tested in rigorously designed RCTs with cost-effectiveness assessed. TRIAL REGISTRATION: Current Controlled Trials ISRCTN35774128. FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 50. See the NIHR Journals Library website for further project information.","Health Technol Assess 19(Number): v-vi, xix-xxv, 1-378","UK",2015,"Various","Unspecified",null,"Adults","CUA","RCT"]
[79,"Sjostrom, M., et al. (2015). \"Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence.\" Neurourol Urodyn 34(3): 244-250.",null,"Sjostrom, M., et al.","Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence","AIMS: To perform a deterministic cost-utility analysis, from a 1-year societal perspective, of two treatment programs for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post. The treatments were compared with each other and with no treatment. METHODS: We performed this economic evaluation alongside a randomized controlled trial. The study included 250 women aged 18-70, with SUI >/= 1 time/week, who were randomized to 3 months of pelvic floor muscle training via either an Internet-based program including e-mail support from an urotherapist (n = 124) or a program sent by post (n = 126). Recruitment was web-based, and participants were self-assessed with validated questionnaires and 2-day bladder diaries, supplemented by a telephone interview with a urotherapist. Treatment costs were continuously registered. Data on participants' time for training, incontinence aids, and laundry were collected at baseline, 4 months, and 1 year. We also measured quality of life with the condition-specific questionnaire ICIQ-LUTSqol, and calculated the quality-adjusted life-years (QALYs) gained. Baseline data remained unchanged for the no treatment option. Sensitivity analysis was performed. RESULTS: Compared to the postal program, the extra cost per QALY for the Internet-based program ranged from 200euro to 7,253euro, indicating greater QALY-gains at similar or slightly higher costs. Compared to no treatment, the extra cost per QALY for the Internet-based program ranged from 10,022euro to 38,921euro, indicating greater QALY-gains at higher, but probably acceptable costs. CONCLUSION: An Internet-based treatment for SUI is a new, cost-effective treatment alternative.","Neurourol Urodyn 34(Number): 244-250","Europe",2015,"Various","Home Based Training",null,"Adults","CUA","RCT"]
[80,"Sopina, E., et al. (2017). \"Cost-effectiveness of a randomised trial of physical activity in Alzheimer's disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark.\" BMJ Open 7(6): e015217.",null,"Sopina, E., et al.","Cost-effectiveness of a randomised trial of physical activity in Alzheimer's disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark","OBJECTIVES: To explore the cost-effectiveness of a supervised moderate-to-high intensity aerobic exercise programme in people diagnosed with Alzheimer's disease (AD) and estimate incremental cost-effectiveness ratios (ICER) using participant-reported and proxy-reported measures of health-related quality of life (HRQoL) DESIGN: A cost-effectiveness analysis of economic and HRQoL data from a randomised trial delivered over 16 weeks. SETTING: Memory clinics in Denmark. PARTICIPANTS: 200 individuals with mild AD aged 50-90 years gave informed consent to participate in the study. Participants were randomised to control or intervention group. INTERVENTIONS: Control group received treatment as usual. The intervention group performed 1 hour of supervised moderate-to-high intensity aerobic exercise three times weekly for 16 weeks. PRIMARY AND SECONDARY OUTCOMES MEASURES: Different physical, functional and health measures were obtained at inclusion (baseline) and 4 and 16 weeks after. HRQoL (EuroQol-5 Dimensions-5 Levels/EQ-Visual Analogue Scale) was reported by the participants and the primary caregivers as proxy respondents. Differences in HRQOL as reported by the participant and caregiver were explored as were different values of caregiver time with respite from care tasks. RESULTS: The intervention cost was estimated at euro608 and euro496 per participant, with and without transport cost, respectively. Participants and caregivers in the intervention group reported a small, positive non-significant improvement in EQ-5D-5L and EQ-VAS after 16 weeks. The ICER was estimated at euro72 000/quality-adjusted life year using participant-reported outcomes and euro87000 using caregiver-reported outcomes. CONCLUSIONS: The findings suggest that the exercise intervention is unlikely to be cost-effective within the commonly applied threshold values. The cost of the intervention might be offset by potential savings from reduction in use of health and social care. TRIAL REGISTRATION NUMBER: https://clinicaltrials.gov/ct2/show/NCT01681602.","BMJ Open 7(Number): e015217","Denmark",2017,"Dementia","Aerobic Training",null,"Adults,Elderly","CUA","RCT"]
[81,"Sutherland, R., et al. (2016). \"Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the 'Physical Activity 4 Everyone' cluster randomized trial.\" Int J Behav Nutr Phys Act 13: 94.",null,"Sutherland, R., et al.","Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the 'Physical Activity 4 Everyone' cluster randomized trial","BACKGROUND: Few school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent populations. As a result, few cost effectiveness analyses have been reported. The aim of this paper is to report the cost and cost effectiveness of the Physical Activity 4 Everyone (PA4E1) intervention which was a multi-component intervention implemented in secondary schools located in low-income communities. Cost effectiveness was assessed using both the physical activity and weight status trial outcomes. METHODS: Intervention and Study Design: The PA4E1 cluster randomised controlled trial was implemented in 10 Australian secondary schools (5 intervention: 5 control) and consisted of intervention schools receiving seven physical activity promotion strategies and six additional strategies that supported school implementation of the intervention components. Costs associated with physical activity strategies, and intervention implementation strategies within the five intervention schools were estimated and compared to the costs of usual physical activity practices of schools in the control group. The total cost of implementing the intervention was estimated from a societal perspective, based on the number of enrolled students in the target grade at the start of the intervention (Grade 7, n = 837). Economic Outcomes: The economic analysis outcomes were cost and incremental cost effectiveness ratios for the following: minutes of moderate-to-vigorous physical activity (MVPA) per day gained, MET hours gained per person/day; Body Mass Index (BMI) unit avoided; and 10% reduction in BMI z-score. RESULTS: The intervention cost AUD $329,952 over 24 months, or AUD$394 per student in the intervention group. This resulted in a cost effectiveness ratio of AUD$56 ($35-$147) per additional minute of MVPA, AUD$1 ($0.6-$2.7) per MET hour gained per person per day, AUD$1408 ($788-$6,570) per BMI unit avoided, and AUD$563 ($282-$3,942) per 10% reduction in BMI z-score. CONCLUSION: PA4E1 is a cost effective intervention for increasing the physical activity levels and reducing unhealthy weight gain in adolescence, a period in which physical activity typically declines. Additional modelling could explore the potential economic impact of the intervention on morbidity and mortality. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000382875.","Int J Behav Nutr Phys Act 13(Number): 94","Australia",2016,"None","Unspecified",null,"Adolescents","CEA","RCT"]
[82,"Swank, M. F., et al. (2015). \"Using frameworks to diagram value in complex policy and environmental interventions to prevent childhood obesity.\" J Public Health Manag Pract 21 Suppl 3: S116-120.",null,"Swank, M. F., et al.","Using frameworks to diagram value in complex policy and environmental interventions to prevent childhood obesity","BACKGROUND: To date, few tools assist policy makers and practitioners in understanding and conveying the implementation costs, potential impacts, and value of policy and environmental changes to address healthy eating, active living, and childhood obesity. For the Evaluation of Healthy Kids, Healthy Communities (HKHC), evaluators considered inputs (resources and investments) that generate costs and savings as well as benefits and harms related to social, economic, environmental, and health-related outcomes in their assessment of 49 HKHC community partnerships funded from 2009 to 2014. METHODS: Using data collected through individual and group interviews and an online performance monitoring system, evaluators created a socioecological framework to assess investments, resources, costs, savings, benefits, and harms at the individual, organizational, community, and societal levels. Evaluators customized frameworks for 6 focal strategies: active transportation, parks and play spaces, child care physical activity standards, corner stores, farmers' markets, and child care nutrition standards. RESULTS: To illustrate the Value Frameworks, this brief highlights the 38 HKHC communities implementing at least 1 active transportation strategy. Evaluators populated this conceptual Value Framework with themes from the strategy-specific inputs and outputs. The range of factors corresponding to the implementation and impact of the HKHC community partnerships are highlighted along with the inputs and outputs. CONCLUSIONS: The Value Frameworks helped evaluators identify gaps in current analysis models (ie, benefit-cost analysis, cost-effectiveness analysis) as well as paint a more complete picture of value for potential obesity prevention strategies. These frameworks provide a comprehensive understanding of investments needed, proposed costs and savings, and potential benefits and harms associated with economic, social, environmental, and health outcomes. This framing also allowed evaluators to demonstrate the interdependence of each socioecological level on the others in these multicomponent interventions. This model can be used by practitioners and community leaders to assess realistic and sustainable strategies to combat childhood obesity.","J Public Health Manag Pract 21 Suppl 3(Number): S116-120","Unclear",2015,"Various","Unspecified",null,"Children","CBA","Cohort"]
[83,"Taddei, C., et al. (2015). \"Cycling promotion and non-communicable disease prevention: health impact assessment and economic evaluation of cycling to work or school in Florence.\" PLoS One 10(4): e0125491.",null,"Taddei, C., et al.","Cycling promotion and non-communicable disease prevention: health impact assessment and economic evaluation of cycling to work or school in Florence","OBJECTIVE: To estimate the effects of cycling promotion on major non-communicable diseases (NCDs) and costs from the public healthcare payer's perspective. DESIGN: Health impact assessment and economic evaluation using a dynamic model over a ten-year period and according to two cycling promotion scenarios. SETTING: Cycling to work or school in Florence, Italy. POPULATION: All individuals aged 15 and older commuting to work or school in Florence. MAIN OUTCOME MEASURES: The primary outcome measures were changes in NCD incidence and healthcare direct costs for the Tuscany Regional Health Service (SST) due to increased cycling. The secondary outcome was change in road traffic accidents. RESULTS: Increasing cycling modal share in Florence from 7.5% to about 17% (Scenario 1) or 27% (Scenario 2) could decrease the incidence of type 2 diabetes by 1.2% or 2.5%, and the incidence of acute myocardial infarction (AMI) and stroke by 0.6% or 1.2%. Within 10 years, the number of cases that can be prevented is 280 or 549 for type 2 diabetes, 51 or 100 for AMI, and 51 or 99 for stroke in Scenario 1 or Scenario 2, respectively. Average annual discounted savings for the SST are estimated to amount to euro400,804 or euro771,201 in Scenario 1 or Scenario 2, respectively. In Florence, due to the high use of vulnerable motorized vehicles (such as scooters, mopeds, and motorcycles), road traffic accidents are expected to decline in both our scenarios. Sensitivity analyses showed that health benefits and savings for the SST are substantial, the most sensitive parameters being the relative risk estimates of NCDs and active commuting. CONCLUSIONS: Effective policies and programs to promote a modal shift towards cycling among students and workers in Florence will contribute to reducing the NCD burden and helping long-term economic sustainability of the SST.","PLoS One 10(Number): e0125491","Italy",2015,"Various","Cycling",null,"Adults","CBA","Cohort"]
[84,"Tan, S. S., et al. (2016). \"Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care.\" Osteoarthritis Cartilage 24(4): 581-588.",null,"Tan, S. S., et al.","Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care","OBJECTIVE: To determine the cost-effectiveness (CE) of exercise therapy (intervention group) compared to 'general practitioner (GP) care' (control group) in patients with hip osteoarthritis (OA) in primary care. METHOD: This cost-utility analysis was conducted with 120 GPs in the Netherlands from the societal and healthcare perspective. Data on direct medical costs, productivity costs and quality of life (QoL) was collected using standardised questionnaires which were sent to the patients at baseline and at 6, 13, 26, 39 and 52 weeks follow-up. All costs were based on Euro 2011 cost data. RESULTS: A total of 203 patients were included. The annual direct medical costs per patient were significantly lower for the intervention group (euro 1233) compared to the control group (euro 1331). The average annual societal costs per patient were lower in the intervention group (euro 2634 vs euro 3241). Productivity costs were higher than direct medical costs. There was a very small adjusted difference in QoL of 0.006 in favour of the control group (95% CI: -0.04 to +0.02). CONCLUSION: Our study revealed that exercise therapy is probably cost saving, without the risk of noteworthy negative health effects. TRIAL REGISTRATION NUMBER: NTR1462.","Osteoarthritis Cartilage 24(Number): 581-588","Netherlands",2016,"Musculoskeletal","Unspecified",null,"Unspecified","CUA","Cohort"]
[85,"Tsiachristas, A., et al. (2015). \"Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands.\" Value Health 18(8): 977-986.",null,"Tsiachristas, A., et al.","Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands","BACKGROUND: Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in The Netherlands to improve care and patient's health behavior. OBJECTIVE: The aim of this study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice. METHODS: We compared the physical activity, smoking status, quality-adjusted life-years, and yearly costs per patient between the most and the least comprehensive DMPs in four disease categories: primary CVR prevention, secondary CVR prevention, both types of CVR prevention, and COPD (N = 1034). Propensity score matching increased comparability between DMPs. A 2-year cost-utility analysis was performed from the health care and societal perspectives. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on cost-effectiveness. RESULTS: Patients in the most comprehensive DMPs increased their physical activity more (except for primary CVR prevention) and had higher smoking cessation rates. The incremental QALYs ranged from -0.032 to 0.038 across all diseases. From a societal perspective, the most comprehensive DMPs decreased costs in primary CVR prevention (certainty 57%), secondary CVR prevention (certainty 88%), and both types of CVR prevention (certainty 98%). Moreover, the implementation of comprehensive DMPs led to QALY gains in secondary CVR prevention (certainty 92%) and COPD (certainty 69%). CONCLUSIONS: The most comprehensive DMPs for CVR and COPD have the potential to be cost saving, effective, or cost-effective compared with the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions that is most suited for each target group.","Value Health 18(Number): 977-986","Netherlands",2015,"Respiratory, Cardiovascular","Various",null,"Unspecified","CUA","Cohort"]
[86,"van Boven, J. F., et al. (2016). \"Effects of targeting disease and medication management interventions towards patients with COPD.\" Curr Med Res Opin 32(2): 229-239.",null,"van Boven, J. F., et al.","Effects of targeting disease and medication management interventions towards patients with COPD","OBJECTIVE: Suboptimal adherence in chronic obstructive pulmonary disease (COPD) patients is associated with decreased clinical and economic outcomes. Intervention programs, targeted at patients with suboptimal adherence and exacerbations, offer opportunities for cost-effective COPD care. We have aimed to assess the effects of the Medication Monitoring and Optimization (MeMO) targeted COPD intervention. METHODS: Twenty community pharmacies participated in this 1 year real-world study with a pre-test/post-test design. Patients with a physician-confirmed COPD diagnosis, oral corticosteroid use, suboptimal adherence and Clinical COPD Questionnaire (CCQ) score >/=1 were selected by pharmacists. Pharmacy interventions included inhalation instruction, medication information and motivational interviewing regarding adherence and smoking cessation. Proposals for dose, medication and/or inhaler change and physical activity or diet recommendations were discussed with the general practitioner (GP), physiotherapist or dietician, when deemed relevant. Primary endpoint was the change in CCQ score. Secondary outcomes were adherence, exacerbations, healthcare utilization, quality of life (EQ-5D), modified Medical Research Council (mMRC) dyspnea score and cost-effectiveness. RESULTS: Interventions were performed in 88 patients (mean age: 69; 52% male; mean CCQ: 2.10). The most often performed interventions were inhalation instruction (89%), medication education (98%) and adherence counseling (58%). Respectively 9%, 45% and 16% were referred to GP, physiotherapist or dietician. After 1 year, mean CCQ decrement was 0.12 and 38% showed a clinically relevant improvement. There was a significant decrease in exacerbations (-0.82) per patient per year. Adherence, mMRC and EQ-5D hardly changed. Per patient, annual medication costs were euro26 higher, interventions cost euro33, but total healthcare costs were euro333 lower. The small sample size and lack of a control group were the main limitations. CONCLUSION: By specifically targeting COPD patients with potential room for improvement, the MeMO COPD program has the potential to be an effective and cost-saving method for preventing exacerbations. However, no effects on quality of life have been observed. Larger studies are therefore recommended.","Curr Med Res Opin 32(Number): 229-239","Netherlands",2016,"Respiratory","Unspecified",null,"Elderly","CUA","Cohort"]
[87,"van den Houten, M. M., et al. (2016). \"Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication.\" Br J Surg 103(12): 1616-1625.",null,"van den Houten, M. M., et al.","Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication","BACKGROUND: Current guidelines recommend supervised exercise therapy (SET) as the preferred initial treatment for patients with intermittent claudication. The availability of SET programmes is, however, limited and such programmes are often not reimbursed. Evidence for the long-term cost-effectiveness of SET compared with endovascular revascularization (ER) as primary treatment for intermittent claudication might aid widespread adoption in clinical practice. METHODS: A Markov model was constructed to determine the incremental costs, incremental quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio of SET versus ER for a hypothetical cohort of patients with newly diagnosed intermittent claudication, from the Dutch healthcare payer's perspective. In the event of primary treatment failure, possible secondary interventions were repeat ER, open revascularization or major amputation. Data sources for model parameters included original data from two RCTs, as well as evidence from the medical literature. The robustness of the results was tested with probabilistic and one-way sensitivity analysis. RESULTS: Considering a 5-year time horizon, probabilistic sensitivity analysis revealed that SET was associated with cost savings compared with ER (-euro6412, 95 per cent credibility interval (CrI) -euro11 874 to -euro1939). The mean difference in effectiveness was -0.07 (95 per cent CrI -0.27 to 0.16) QALYs. ER was associated with an additional euro91 600 per QALY gained compared with SET. One-way sensitivity analysis indicated more favourable cost-effectiveness for ER in subsets of patients with low quality-of-life scores at baseline. CONCLUSION: SET is a more cost-effective primary treatment for intermittent claudication than ER. These results support implementation of supervised exercise programmes in clinical practice.","Br J Surg 103(Number): 1616-1625","Netherlands",2016,"Cardiovascular","Supervised Exercise Therapy",null,"Unspecified","CUA","Cohort"]
[88,"van der Velde, G., et al. (2016). \"Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.\" Spine J 16(12): 1582-1597.",null,"van der Velde, G., et al.","Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration","BACKGROUND CONTEXT: Whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD) are prevalent conditions that impact society and impose a significant economic burden on health-care systems. Health economic evidence on WAD and NAD interventions has been sparse: only three economic evaluations of interventions for NAD were identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (NPTF). An updated overview is needed to inform health-care policy and guidelines. PURPOSE: This study aimed to determine the cost-effectiveness of interventions for grades I-III WAD and NAD in children and adults. STUDY DESIGN: Systematic review of health economic literature, best-evidence synthesis. METHODS: We systematically searched CINAHL, the Cochrane economic databases (Health Technology Assessment, NHS Economic Evaluation Database), EconLit, EMBASE, MEDLINE, PsycINFO, and Tufts CEA Registry from 2000 to 2015 for economic evaluations of WAD and NAD interventions. We appraised relevant evaluations using the Scottish Intercollegiate Guidelines Network Methodology Criteria for Economic Evaluations. We extracted data, including mean costs (standardized to 2013 Canadian dollars [CAD]) and quality-adjusted life years (QALYs), from studies with adequate methodological quality. We recalculated cost-effectiveness statistics based on the standardized currency using a willingness-to-pay of CAD $50,000 per additional QALY. Funding was provided by the Ministry of Finance. RESULTS: Our search identified 1,616 citations. Six studies fulfilled our selection criteria, including three studies previously reviewed by the NPTF. Structured education appears cost-effective for adults with WAD. For adults with NAD, acupuncture added to routine medical care; manual therapy; multimodal care that includes manual therapy; advice and exercise; and psychological care using cognitive-behavioral therapy appear cost-effective. In contrast, adding manual therapy or diathermy to advice and exercise; multimodal care by a physiotherapist or physician; and behavioral-graded activity do not appear cost-effective for adults with NAD. CONCLUSIONS: Our review adds to the findings of the NPTF. Recent evidence suggests that structured education is cost-effective for WAD, whereas advice and exercise and multimodal care that include manual therapy are cost-effective for NAD. Obtaining more robust health economic evidence for non-invasive interventions for WAD and NAD in children and adults remains an essential research priority.","Spine J 16(Number): 1582-1597","Canada",2016,"Musculoskeletal","Unspecified",null,"Children,Adults","CUA","SLR"]
[89,"Veerman, J. L., et al. (2016). \"Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study.\" BMJ Open 6(9): e011617.",null,"Veerman, J. L., et al.","Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study","BACKGROUND: Studies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking. METHODS: Using data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years. RESULTS: Installing and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness. CONCLUSIONS: In low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might consider a more comprehensive assessment of its social value (eg, social cohesion, safety and air quality).","BMJ Open 6(Number): e011617","Australia",2016,"None","Walking",null,"Adults","CUA","Cohort"]
[90,"Verhoef, T. I., et al. (2016). \"Cost-effectiveness of a physical exercise programme for residents of care homes: a pilot study.\" BMC Geriatr 16: 83.",null,"Verhoef, T. I., et al.","Cost-effectiveness of a physical exercise programme for residents of care homes: a pilot study","BACKGROUND: Oomph! Wellness organises interactive exercise and activity classes (Oomph! classes) for older people in care homes. We investigated the cost-effectiveness of Oomph! classes. METHODS: Health-related quality of life was measured using the EQ-5D-5 L questionnaire at three time points; 3 months and 1 week prior to the start of the classes and after 3 months of Oomph! classes. Costs included the costs of organising the classes, training instructors and health service use (General Practitioner (GP) and hospital outpatient visits). To determine the cost-effectiveness of Oomph! classes, total costs and quality-adjusted life-years (QALYs) during the 3 months after initiation of the classes were compared to the total costs and QALYs of the 3 months prior to the classes and extrapolated to a 1-year time horizon. Uncertainty was taken into account using one-way and probabilistic sensitivity analysis. RESULTS: Sixteen residents completed all three EQ-5D-5 L questionnaires. There was a decrease in mean health related quality of life per participant in the 3 months before Oomph! classes (0.56 to 0.52, p = 0.26) and an increase in the 3 months after the start of Oomph! classes (0.52 to 0.60, p = 0.06), but the changes were not statistically significant. There were more GP visits after the start of Oomph! classes and fewer hospital outpatient visits, leading to a slight decrease in NHS costs (mean pound132 vs pound141 per participant), but the differences were not statistically significant (p = 0.79). In the base case scenario, total costs for Oomph! classes were pound113 higher per participant than without Oomph! classes ( pound677 vs pound564) and total QALYs were 0.074 higher (0.594 vs 0.520). The incremental costs per QALY gained were therefore pound1531. The 95 % confidence intervals around the cost/QALY gained varied from dominant to dominated, meaning there was large uncertainty around the cost-effectiveness results. Given a willingness to pay threshold of pound20,000 per QALY gained, Oomph! classes had a 62 %-86 % probability of being cost-effective depending on the scenario used. CONCLUSIONS: Preliminary evidence suggests that Oomph! classes may be cost-effective, but further evidence is needed about its impact on health-related quality of life and health service use.","BMC Geriatr 16(Number): 83","UK",2016,"Various","Unspecified",null,"Elderly","CUA","Cohort"]
[91,"Verhoef, T. I., et al. (2016). \"Cost-effectiveness analysis of offering free leisure centre memberships to physically inactive members of the public receiving state benefits: a case study.\" BMC Public Health 16: 616.",null,"Verhoef, T. I., et al.","Cost-effectiveness analysis of offering free leisure centre memberships to physically inactive members of the public receiving state benefits: a case study","BACKGROUND: We evaluated the cost-effectiveness of the Give-it-a-Go programme, which offers free leisure centre memberships to physically inactive members of the public in a single London Borough receiving state benefits. METHODS: A decision analytic Markov model was developed to analyse lifetime costs and quality-adjusted life-years (QALYs) of 1025 people recruited to the intervention versus no intervention. In the intervention group, people were offered 4 months of free membership at a leisure centre. Physical activity levels were assessed at 0 and 4 months using the International Physical Activity Questionnaire (IPAQ). Higher levels of physical activity were assumed to decrease the risk of coronary heart disease, stroke and diabetes mellitus type II, as well as improve mental health. Costs were assessed from a National Health Service (NHS) perspective. Uncertainty was assessed using one-way and probabilistic sensitivity analyses. RESULTS: One-hundred fifty nine participants (15.5 %) completed the programme by attending the leisure centre for 4 months. Compared with no intervention, Give it a Go increased costs by pound67.25 and QALYs by 0.0033 (equivalent to 1.21 days in full health) per recruited person. The incremental costs per QALY gained were pound20,347. The results were highly sensitive to the magnitude of mental health gain due to physical activity and the duration of the effect of the programme (1 year in the base case analysis). When the mental health gain was omitted from the analysis, the incremental cost per QALY gained increased to almost pound1.5 million. In the probabilistic sensitivity analysis, the incremental costs per QALY gained were below pound20,000 in 39 % of the 5000 simulations. CONCLUSIONS: Give it a Go did not significantly increase life-expectancy, but had a positive influence on quality of life due to the mental health gain of physical activity. If the increase in physical activity caused by Give it a Go lasts for more than 1 year, the programme would be cost-effective given a willingness to pay for a QALY of pound20,000.","BMC Public Health 16(Number): 616","UK",2016,"None","Unspecified",null,"Any","CUA","Cohort"]
[92,"Walsh, T. S., et al. (2015). \"Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial.\" JAMA Intern Med 175(6): 901-910.",null,"Walsh, T. S., et al.","Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial","IMPORTANCE: Critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. OBJECTIVE: To evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post-intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. DESIGN, SETTING, AND PARTICIPANTS: A parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. INTERVENTIONS: During the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. MAIN OUTCOMES AND MEASURES: The Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). RESULTS: Median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, -0.2 [95% CI, -1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, -0.1 [95% CI, -3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, -3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. CONCLUSIONS AND RELEVANCE: Post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery. TRIAL REGISTRATION: isrctn.com Identifier: ISRCTN09412438.","JAMA Intern Med 175(Number): 901-910","UK",2015,"Various","Physiotherapy",null,"Any","CUA","RCT"]
[93,"Wang, H., et al. (2017). \"Cost-Effectiveness of Ready for Recess to Promote Physical Activity in Children.\" J Sch Health 87(4): 278-285.",null,"Wang, H., et al.","Cost-Effectiveness of Ready for Recess to Promote Physical Activity in Children","BACKGROUND: Many school-based recess interventions have been shown to be effective in increasing physical activity but their relative efficiency compared to other school-based programs are unknown. This study examined the cost-effectiveness of Ready for Recess, a program designed to increase students' physical activity in 2 elementary schools. METHODS: Standard cost-effectiveness analysis method was used from a program's perspective for this study. Program effectiveness was measured as total metabolic equivalent (MET) hours gained. Program costs included equipment, training, and personnel costs during the 1-year intervention. The cost-effectiveness was measured as the ratio of program costs to total MET-hours gained. RESULTS: Ready for Recess cost $27,643.97 for the 2 schools in the first year of implementation. Physical activity increased by 1.8 MET-hours per day per student. Approximately 32 cents were spent on Ready for Recess to produce an additional MET-hour per student per school day in the 2008-2009 school year. CONCLUSIONS: Ready for Recess was cost-effective in its first year of implementation using 35 cents as a benchmark and it was cost-effective relative to other school-based physical activity interventions. The program may be more cost-effective if implemented for a longer time and on a larger scale.","J Sch Health 87(Number): 278-285","USA",2017,"None","Multiple",null,"Children","CEA","Cohort"]
[94,"Whelan, M. E., et al. (2016). \"Feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss program delivered via a hospital outpatient setting.\" Transl Behav Med 6(3): 386-395.",null,"Whelan, M. E., et al.","Feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss program delivered via a hospital outpatient setting","Engaging patients in a group-based weight loss program is a challenge for the acute-care hospital outpatient setting. To evaluate the feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss service and an existing face-to-face, group-based service a non-randomised, two-arm feasibility trial was used. Patients who declined a two-month existing outpatient group-based program were offered a six-month research-based telephone program. Outcomes were assessed at baseline, two months (both groups) and six months (telephone program only) using paired t tests and linear regression models. Cost per healthy life year gained was calculated for both programs. The telephone program achieved significant weight loss (-4.1 +/- 5.0 %; p = 0.001) for completers (n = 35; 57 % of enrolees) at six months. Compared to the group-based program (n = 33 completers; 66 %), the telephone program was associated with greater weight loss (mean difference [95%CI] -2.0 % [-3.4, -0.6]; p = 0.007) at two months. The cost per healthy life year gained was $33,000 and $85,000, for the telephone and group program, respectively. Telephone-delivered weight management services may be effective and cost-effective within an acute-care hospital setting, likely more so than usual (group-based) care.","Transl Behav Med 6(Number): 386-395","Australia",2016,"Various","Unspecified",null,"Unspecified","CEA","Cohort"]
[95,"Williams, M. A., et al. (2015). \"Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation.\" Health Technol Assess 19(19): 1-222.",null,"Williams, M. A., et al.","Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation","BACKGROUND: The effectiveness of exercise for improving hand and wrist function in people with rheumatoid arthritis (RA) is uncertain. OBJECTIVES: The study aims were (1) to estimate the clinical effectiveness and cost-effectiveness of adding an optimised exercise programme for hands and upper limbs to standard care for patients with RA; and (2) to qualitatively describe the experience of participants in the trial with a particular emphasis on acceptability of the intervention, exercise behaviours and reasons for adherence/non-adherence. DESIGN: A pragmatic, multicentred, individually randomised controlled trial with an embedded qualitative study. Outcome assessors were blind to group assignment and independent of treatment delivery. SETTING: Seventeen NHS trusts in England comprising 21 rheumatology and therapy departments. PARTICIPANTS: Adults with RA who had pain and dysfunction of the hands and/or wrists and had been on stable medication for at least 3 months. Patients were excluded if they were under 18 years old, had undergone upper limb surgery/fracture in the last 6 months, were on a waiting list for upper limb surgery or were pregnant. INTERVENTIONS: Usual care or usual care plus an individualised exercise programme. Usual care consisted of joint protection education, general exercise advice and functional splinting if required. The exercise programme consisted of six sessions of strengthening and stretching exercises with a hand therapist, daily home exercises and strategies to maximise adherence. MAIN OUTCOME MEASURES: The primary outcome was the Michigan Hand Outcome Questionnaire (MHQ) overall hand function subscale score at 12 months. Secondary outcome measures included the full MHQ, pain, health-related quality of life (Short Form questionnaire-12 items), impairment (grip strength, dexterity and range of motion) and self-efficacy. European Quality of Life-5 Dimensions, medication and health-care use were collected for the health economics evaluation. Follow-up was at 4 and 12 months post randomisation. Analysis was performed on an intention-to-treat basis. RESULTS: We randomised 490 patients (244 to usual care, 246 to exercise programme). Compliance with the treatments was very good (93% of usual care participants and 75% of exercise programme participants completed treatment). Outcomes were obtained for 89% of participants at 12 months (222 for usual care, 216 for exercise programme). There was a statistically significant difference in favour of the exercise programme for the primary outcome at 4 and 12 months [mean difference 4.6 points, 95% confidence interval (CI) 2.2 to 7.0 points; and mean difference 4.4 points, 95% CI 1.6 to 7.1 points, respectively]. There were no significant differences in pain scores or adverse events. The estimated difference in mean quality-adjusted life-years (QALYs) accrued over 12 months was 0.01 greater (95% CI -0.03 to 0.05) in the exercise programme group. Imputed analysis produced incremental cost-effectiveness ratio estimates of pound17,941 (0.59 probability of cost-effectiveness at willingness-to-pay threshold of pound30,000 per QALY). The qualitative study found the exercise programme to be acceptable and highlighted the importance of the therapist in enabling patients to establish a routine and incorporate the exercises into their lives. CONCLUSIONS: The results of the Strengthening And stretching for Rheumatoid Arthritis of the Hand trial suggest that the addition of an exercise programme for RA hands/wrists to usual care is clinically effective and cost-effective when compared with usual care alone. No adverse effects were associated with the exercise programme. The economic analysis suggests that the intervention is likely to be cost-effective. STUDY REGISTRATION: Current Controlled Trials ISRCTN 89936343.","Health Technol Assess 19(Number): 1-222","UK",2015,"Musculoskeletal","Strength and Stretch Hand",null,"Unspecified","CUA","RCT"]
[96,"Wilson, K. J., et al. (2015). \"Cost-effectiveness of a community-based weight control intervention targeting a low-socioeconomic-status Mexican-origin population.\" Health Promot Pract 16(1): 101-108.",null,"Wilson, K. J., et al.","Cost-effectiveness of a community-based weight control intervention targeting a low-socioeconomic-status Mexican-origin population","INTRODUCTION: The objective of our study was to evaluate the cost-effectiveness of a community-based intervention designed to improve physical activity levels and dietary intake and to reduce diabetes risk in a largely Hispanic population residing along the U.S.-Mexico border. METHOD: We forecasted disease outcomes, quality-adjusted life-years (QALYs) gained, and lifetime costs associated with actual and projected attainment of 2% and 5% weight loss taking a societal cost perspective. We extrapolated changes in beverage calorie consumption between baseline and 6-month follow-up to attain projected weight loss measures. Outcomes were projected 5, 10, and 20 years into the future and discounted at a 3.0% rate. RESULTS: The incremental cost-effectiveness ratio was $57,430 and $61,893, respectively, per QALY gained when compared with usual care for the 2% and 5% weight loss scenarios. The intervention was particularly cost-effective for morbidly obese participants. Cost-effectiveness improves when using 3-year weight loss projections based on changes in sugar-sweetened beverage caloric consumption to $49,478 and $24,092 for the 2% and 5% weight loss scenarios. CONCLUSIONS: This analysis demonstrates that a culturally sensitive community-based weight loss and maintenance intervention can be cost-effective even when healthy weight individuals participate.","Health Promot Pract 16(Number): 101-108","USA",2015,"None","Unspecified",null,"Unspecified","CUA","Cohort"]
[97,"Wright, D. R., et al. (2015). \"Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S.\" Am J Prev Med 49(1): 135-147.",null,"Wright, D. R., et al.","Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S","INTRODUCTION: Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities. METHODS: Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention's impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3% annually. Probabilistic sensitivity analyses simulated 95% uncertainty intervals (UIs) around outcomes. RESULTS: Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95% UI=$14.2, $134) million. The intervention is 94.7% likely to be cost saving by 2025. CONCLUSIONS: Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.","Am J Prev Med 49(Number): 135-147","USA",2015,"None","Unspecified",null,"Children","CEA","Cohort"]
[98,"Zapata-Diomedi, B., et al. (2016). \"The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia.\" Health Place 42: 19-29.",null,"Zapata-Diomedi, B., et al.","The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia","Attributes of the built environment can positively influence physical activity of urban populations, which results in health and economic benefits. In this study, we derived scenarios from the literature for the association built environment-physical activity and used a mathematical model to translate improvements in physical activity to health-adjusted life years and health care costs. We modelled 28 scenarios representing a diverse range of built environment attributes including density, diversity of land use, availability of destinations, distance to transit, design and neighbourhood walkability. Our results indicated potential health gains in 24 of the 28 modelled built environment attributes. Health care cost savings due to prevented physical activity-related diseases ranged between A$1300 to A$105,355 per 100,000 adults per year. On the other hand, additional health care costs of prolonged life years attributable to improvements in physical activity were nearly 50% higher than the estimated health care costs savings. Our results give an indication of the potential health benefits of investing in physical activity-friendly built environments.","Health Place 42(Number): 19-29","Australia",2016,"None","Unspecified",null,"Adults","CBA","Cohort"]
[99,"Zivin, K., et al. (2017). \"Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees.\" Am J Prev Med 52(3): 347-352.",null,"Zivin, K., et al.","Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees","INTRODUCTION: Employee wellness programs show mixed effectiveness results. This study examined the impact of an insurer's lifestyle modification program on healthcare costs of obese individuals. METHODS: This nonrandomized comparative effectiveness study evaluated changes in healthcare costs for participants in two incentivized programs, an Internet-mediated pedometer-based walking program (WalkingSpree, n=7,594) and an in-person weight-loss program (Weight Watchers, n=5,764). The primary outcome was the change in total healthcare costs from the baseline year to the year after program participation. Data were collected from 2009 to 2011 and the analysis was done in 2014-2015. RESULTS: After 1 year, unadjusted mean costs decreased in both programs, with larger decreases for Weight Watchers participants than WalkingSpree participants (-$1,055.39 vs -$577.10, p=0.019). This difference was driven by higher rates of women in Weight Watchers, higher baseline total costs among women, and a greater decrease in costs for women in Weight Watchers (-$1,037.60 vs -$388.50, p=0.014). After adjustment for baseline costs, there were no differences by program or gender. CONCLUSIONS: Comparable cost reductions in both programs suggest that employers may want to offer more than one choice of incentivized wellness program with monitoring to meet the diverse needs of employees.","Am J Prev Med 52(Number): 347-352","USA",2017,"Various","Walking",null,"Unspecified","CCA","Cohort"]
[100,"Zwerink, M., et al. (2016). \"Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management.\" Copd 13(2): 214-223.",null,"Zwerink, M., et al.","Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management","INTRODUCTION: Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up. METHODS: All included COPD patients participated in four self-management sessions. Additionally, patients in the COPE-active group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained 3 times/week for 6 months and two times/week during the subsequent 5 months. In both periods, one of these weekly training sessions was home-based (unsupervised). No formal physiotherapy sessions were offered to COPE-active patients in the second year. A decision analytical model with a 24-month perspective was used to evaluate cost-effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated and cost-effectiveness planes were created. RESULTS: Data of 77 patients participating in the exercise programme and 76 patients in the control group were analysed. The ICER for an additional patient prevented from deteriorating at least 47.5 meters on the ISWT was euro6257. The ICER for an additional patient with a clinically relevant improvement (>/= 500 steps/day) in physical activity was euro1564, and the ICER for an additional quality-adjusted life year (QALY) was euro10 950. CONCLUSION: Due to a lack of maintenance of beneficial effects on our primary outcome exercise capacity after 2 years of follow-up and higher costs of the programme, the community-based exercise programme cannot be considered cost-effective compared to self-management programmes only. Nevertheless, the ICERs for the secondary outcomes physical activity and QALY are generally considered acceptable.","Copd 13(Number): 214-223","Netherlands",2016,"Respiratory","Walking",null,"Unspecified","CEA,CUA","Cohort"]

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[1,"Aboagye,E.,et al. (2015). \"Cost-effectiveness of early interventions for non-specific low back pain: a randomized controlled study investigating medical yoga,exercise therapy and self-care advice.\" J Rehabil Med 47(2): 167-173.",null,"Aboagye,E.,et al.","Cost-effectiveness of early interventions for non-specific low back pain: a randomized controlled study investigating medical yoga,exercise therapy and self-care advice","OBJECTIVE: To evaluate the cost-effectiveness of medical yoga as an early intervention compared with evidence-based exercise therapy and self-care advice for non-specific low back pain. DESIGN: Randomized controlled trial with a cost-effectiveness analysis. SUBJECTS: A total of 159 participants randomized into the medical yoga group (n = 52),the exercise therapy group (n = 52) and the self-care advice group (n = 55). METHODS: The health outcome measure EQ-5D was applied to measure quality of life data combined with cost data collected from treatment groups from baseline to 12 months follow-up. Outcome measure was health-related quality of life (HRQL). Incremental cost per quality adjusted life year (QALY) was also calculated. Cost-effectiveness analysis was conducted primarily from the societal and employer perspectives. RESULTS: Medical yoga is cost-effective compared with self-care advice if an employer considers the significant improvement in the HRQL of an employee with low back pain justifies the additional cost of treatment (i.e. in this study EUR 150). From a societal perspective,medical yoga is a cost-effective treatment compared with exercise therapy and self-care advice if an additional QALY is worth EUR 11,500. Sensitivity analysis suggests that medical yoga is more cost-effective than its alternatives. CONCLUSION: Six weeks of uninterrupted medical yoga thera-py is a cost-effective early intervention for non-specific low back pain,when treatment recommendations are adhered to.","J Rehabil Med 47(Number): 167-173","Unclear",2015,"Musculoskeletal","Medical Yoga",null,"Unspecified","CUA","RCT","Unclear","Unspecified","Musculoskeletal","Medical Yoga","CUA","RCT",null,"2015:2015"]
[2,"Adie,K.,et al. (2017). \"Does the use of Nintendo Wii Sports(TM) improve arm function? Trial of Wii(TM) in Stroke: a randomized controlled trial and economics analysis.\" Clin Rehabil 31(2): 173-185.",null,"Adie,K.,et al.","Does the use of Nintendo Wii Sports(TM) improve arm function? Trial of Wii(TM) in Stroke: a randomized controlled trial and economics analysis","OBJECTIVE: The Trial of Wii in Stroke investigated the efficacy of using the Nintendo Wii Sports (Wii(TM)) to improve affected arm function after stroke. DESIGN: Multicentre,pragmatic,parallel group,randomized controlled trial. SETTING: Home-based rehabilitation. SUBJECTS: A total of 240 participants aged 24-90 years with arm weakness following a stroke within the previous six months. INTERVENTION: Participants were randomly assigned to exercise daily for six weeks using the Wii(TM) or arm exercises at home. MAIN MEASURES: Primary outcome was change in the affected arm function at six weeks follow-up using the Action Research Arm Test. Secondary outcomes included occupational performance,quality of life,arm function at six months and a cost effectiveness analysis. RESULTS: The study was completed by 209 participants (87.1%). There was no significant difference in the primary outcome of affected arm function at six weeks follow-up (mean difference -1.7,95% CI -3.9 to 0.5,p = 0.12) and no significant difference in secondary outcomes,including occupational performance,quality of life or arm function at six months,between the two groups. No serious adverse events related to the study treatment were reported. The cost effectiveness analysis showed that the Wii(TM) was more expensive than arm exercises pound1106 (SD 1656) vs. pound730 (SD 829) (probability 0.866). CONCLUSION: The trial showed that the Wii(TM) was not superior to arm exercises in home-based rehabilitation for stroke survivors with arm weakness. The Wii(TM) was well tolerated but more expensive than arm exercises.","Clin Rehabil 31(Number): 173-185","UK",2017,"Various","Home Based Training",null,"Adults,Elderly","CEA","RCT","UK","Adults,Elderly","Various","Home Based Training","CEA","RCT",null,"2017:2018"]
[3,"Akanni,O. O.,et al. (2017). \"Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select.\" Int J Environ Res Public Health 14(5): 10.3390/ijerph14050545",null,"Akanni,O. O.,et al.","Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select","The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select,a community-based health promotion program previously shown to improve functional health,physical activity,nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach,personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained,as well as health outcomes,such as healthy days,weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days,physical activity and nutrition-related outcomes among participants,this study supports the use of Texercise Select as an intervention with substantial health and cost benefits.","Int J Environ Res Public Health 14(Number): ","USA",2017,"None","Texercise Select",null,"Elderly","CUA","Cohort","USA","Elderly","None","Texercise Select","CUA","Cohort",null,"2017:2018"]
[4,"Andronis,L.,et al. (2017). \"Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review.\" Appl Health Econ Health Policy 15(2): 173-201.",null,"Andronis,L.,et al.","Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review","BACKGROUND: Low back pain (LBP) is a major health problem,having a substantial effect on peoples' quality of life and placing a significant economic burden on healthcare systems and,more broadly,societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear. OBJECTIVES: To identify,document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP. METHODS: Relevant studies were identified through systematic searches in bibliographic databases (EMBASE,MEDLINE,PsycINFO,Cochrane Library,CINAHL and the National Health Service Economic Evaluation Database),'similar article' searches and reference list scanning. Study selection was carried out by three assessors,independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms. RESULTS: Thirty-three studies were identified. Study interventions were categorised as: (1) combined physical exercise and psychological therapy,(2) physical exercise therapy only,(3) information and education,and (4) manual therapy. Interventions assessed within each category varied in terms of their components and delivery. In general,combined physical and psychological treatments,information and education interventions,and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole,with yoga,but not group exercise,being cost effective. CONCLUSIONS: The identified evidence suggests that combined physical and psychological treatments,medical yoga,information and education programmes,spinal manipulation and acupuncture are likely to be cost-effective options for LBP.","Appl Health Econ Health Policy 15(Number): 173-201","International",2017,"Musculoskeletal","Unspecified",null,"Unspecified","CEA","SLR","International","Unspecified","Musculoskeletal","Unspecified","CEA","SLR",null,"2017:2018"]
[5,"Barrett,J. L.,et al. (2015). \"Cost Effectiveness of an Elementary School Active Physical Education Policy.\" Am J Prev Med 49(1): 148-159.",null,"Barrett,J. L.,et al.","Cost Effectiveness of an Elementary School Active Physical Education Policy","INTRODUCTION: Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA,less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state \"active PE\" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA. METHODS: A cohort model was used to simulate the impact of an active PE policy on physical activity,BMI,and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014. RESULTS: An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23,2.51) and cost $70.7 million (95% UI=$51.1,$95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15,$2.15),and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148,$3,100). From 2015 to 2025,the policy would cost $235 million (95% UI=$170 million,$319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million,$153 million). CONCLUSIONS: Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.","Am J Prev Med 49(Number): 148-159","USA",2015,"None","Unspecified",null,"Adolescents","CEA","Cohort","USA","Adolescents","None","Unspecified","CEA","Cohort",null,"2015:2015"]
[6,"Benmarhnia,T.,et al. (2017). \"Investing in a healthy lifestyle strategy: is it worth it?\" Int J Public Health 62(1): 3-13.",null,"Benmarhnia,T.,et al.","Investing in a healthy lifestyle strategy: is it worth it?","OBJECTIVES: In Quebec,various actors fund activities aimed at increasing physical activity,improving eating habits and reducing smoking. The objective was to evaluate how effective does the healthy lifestyle habits promotion (HLHP) strategy need to be to make to offset its costs. METHODS: First,we built the logic model of the HLHP strategy. We then assessed the strategy's total cost as well as the direct health care expenditures associated with lifestyle-related risk factors (smoking,physical inactivity,insufficient intake of fruits and vegetables,obesity and overweight). Finally,we estimated the break-even point beyond which the economic benefits of the HLHP strategy would outweigh its costs. RESULTS: The HLHP strategy cost for 2010-2011 was estimated at $110 million. Direct healthcare expenditures associated with lifestyle-related risk factors were estimated at $4.161 billion. We estimated that 47 % of these expenditures were attributable to these risk factors. CONCLUSIONS: We concluded that the HLHP strategy cost corresponded to 5.6 % of the annual healthcare expenditures attributable to these risk factors. This study compared the economic value of HLHP activities against healthcare expenditures associated with targeted risk factors.","Int J Public Health 62(Number): 3-13","Canada",2017,"None","Unspecified",null,"Unspecified","CBA","Cohort","Canada","Unspecified","None","Unspecified","CBA","Cohort",null,"2017:2018"]
[7,"Bennell,K. L.,et al. (2016). \"Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial.\" Arthritis Care Res (Hoboken) 68(5): 590-602.",null,"Bennell,K. L.,et al.","Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial","OBJECTIVE: To investigate whether a 12-week physical therapist-delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA). METHODS: This was an assessor-blinded,3-arm randomized controlled trial in 222 people (73 PCST/exercise,75 exercise,and 74 PCST) ages >/=50 years with knee OA. All participants received 10 treatments over 12 weeks plus a home program. PCST covered pain education and training in cognitive and behavioral pain coping skills,exercise comprised strengthening exercises,and PCST/exercise integrated both. Primary outcomes were self-reported average knee pain (visual analog scale,range 0-100 mm) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index,range 0-68) at week 12. Secondary outcomes included other pain measures,global change,physical performance,psychological health,physical activity,quality of life,and cost effectiveness. Analyses were by intent-to-treat methodology with multiple imputation for missing data. RESULTS: A total of 201 participants (91%),181 participants (82%),and 186 participants (84%) completed week 12,32,and 52 measurements,respectively. At week 12,there were no significant between-group differences for reductions in pain comparing PCST/exercise versus exercise (mean difference 5.8 mm [95% confidence interval (95% CI) -1.4,13.0]) and PCST/exercise versus PCST (6.7 mm [95% CI -0.6,14.1]). Significantly greater improvements in function were found for PCST/exercise versus exercise (3.7 units [95% CI 0.4,7.0]) and PCST/exercise versus PCST (7.9 units [95% CI 4.7,11.2]). These differences persisted at weeks 32 (both) and 52 (PCST). Benefits favoring PCST/exercise were seen on several secondary outcomes. Cost effectiveness of PCST/exercise was not demonstrated. CONCLUSION: This model of care could improve access to psychological treatment and augment patient outcomes from exercise in knee OA,although it did not appear to be cost effective.","Arthritis Care Res (Hoboken) 68(Number): 590-602","UK,Australia,Canada",2016,"Musculoskeletal","PCST",null,"Elderly","CEA","RCT","UK,Australia,Canada","Elderly","Musculoskeletal","PCST","CEA","RCT",null,"2016:2016"]
[8,"Blanchette,M. A.,et al. (2016). \"Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies.\" PLoS One 11(8): e0160037.",null,"Blanchette,M. A.,et al.","Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies","BACKGROUND CONTEXT: Low back pain (LBP) is one of the leading causes of disability worldwide and among the most common reasons for seeking primary sector care. Chiropractors,physical therapists and general practitioners are among those providers that treat LBP patients,but there is only limited evidence regarding the effectiveness and economic evaluation of care offered by these provider groups. PURPOSE: To estimate the clinical effectiveness and to systematically review the literature of full economic evaluation of chiropractic care compared to other commonly used care approaches among adult patients with non-specific LBP. STUDY DESIGN: Systematic reviews of interventions and economic evaluations. METHODS: A comprehensive search strategy was conducted to identify 1) pragmatic randomized controlled trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared to standard care delivered by other healthcare providers. Studies published between 1990 and 4th June 2015 were considered. Primary outcomes included pain,functional status and global improvement. Study selection,critical quality appraisal and data extraction were conducted by two independent reviewers. Data from RCTs with low risk of bias were included in a meta-analysis to determine effect estimates. Cost estimates of full economic evaluations were converted to 2015 USD and results summarized using Slavin's qualitative best-evidence synthesis. RESULTS: Six RCTs and three full economic evaluations were scientifically admissible. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1),physical therapy (n = 3) and medical care (n = 1). Overall,we found similar effects for chiropractic care and the other types of care and no reports of serious adverse events. Three low to high quality full economic evaluations studies (one cost-effectiveness,one cost-minimization and one cost-benefit) compared chiropractic to medical care. Given the divergent conclusions (favours chiropractic,favours medical care,equivalent options),mixed-evidence was found for economic evaluations of chiropractic care compared to medical care. CONCLUSION: Moderate evidence suggests that chiropractic care for LBP appears to be equally effective as physical therapy. Limited evidence suggests the same conclusion when chiropractic care is compared to exercise therapy and medical care although no firm conclusion can be reached at this time. No serious adverse events were reported for any type of care. Our review was also unable to clarify whether chiropractic or medical care is more cost-effective. Given the limited available evidence,the decision to seek or to refer patients for chiropractic care should be based on patient preference and values. Future studies are likely to have an important impact on our estimates as these were based on only a few admissible studies.","PLoS One 11(Number): e0160037","International",2016,"Musculoskeletal","Unspecified",null,"Unspecified","CEA,CBA,CMA","SLR","International","Unspecified","Musculoskeletal","Unspecified","CEA,CBA,CMA","SLR",null,"2016:2016"]
[9,"Brodin,N.,et al. (2015). \"Cost-effectiveness of a one-year coaching program for healthy physical activity in early rheumatoid arthritis.\" Disabil Rehabil 37(9): 757-762.",null,"Brodin,N.,et al.","Cost-effectiveness of a one-year coaching program for healthy physical activity in early rheumatoid arthritis","PURPOSE: To describe cost-effectiveness of the Physical Activity in Rheumatoid Arthritis (PARA) study intervention. METHOD: Costs were collected and estimated retrospectively. Cost-effectiveness was calculated based on the intervention cost per patient with respect to change in health status (EuroQol global visual analog scale--EQ-VAS and EuroQol--EQ-5D) and activity limitation (Health assessment questionnaire - HAQ) using cost-effectiveness- and cost-minimization analyses. RESULTS: Total cost of the one-year intervention program was estimated to be euro67 317 or euro716 per participant. Estimated difference in total societal cost between the intervention (IG) and control (CG) was euro580 per participant. Incremental cost-effectiveness ratio (ICER) for one point (1/100) of improvement in EQ-VAS was estimated to be euro116. By offering the intervention to more affected participants in the IG compared to less affected participants,15.5 extra points of improvement in EQ-VAS and 0.13 points of improvement on HAQ were gained at the same cost. \"Ordinary physiotherapy\" was most cost-effective with regard to EQ-5D. CONCLUSIONS: The intervention resulted in improved effect in health status for the IG with a cost of euro116 per extra point in VAS. The intervention was cost-effective if targeted towards a subgroup of more affected patients when evaluating the effect using VAS and HAQ. IMPLICATIONS FOR REHABILITATION: The physical activity coaching intervention resulted in an improved effect on VAS for the intervention group,to a higher cost. In order to maximize cost-effectiveness,this type of physical activity coaching intervention should be targeted towards patients largely affected by their RA. The intervention is cost-effective from the patients' point of view,but not from that of the general population.","Disabil Rehabil 37(Number): 757-762","Unclear",2015,"Musculoskeletal","Unspecified",null,"Unspecified","CUA,CMA","Cohort","Unclear","Unspecified","Musculoskeletal","Unspecified","CUA,CMA","Cohort",null,"2015:2015"]
[10,"Brown,V.,et al. (2017). \"Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study.\" BMC Public Health 17(1): 359.",null,"Brown,V.,et al.","Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study","BACKGROUND: Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments,thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. METHODS: A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity,injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis. RESULTS: Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity,whilst nine studies reported associations specifically with physical activity,walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary,with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained,AUD2.6 M in healthcare cost savings),measured against a comparator of no additional increase in fuel excise. Under \"best case\" assumptions,the intervention would be more cost-effective (3181 HALYs gained,AUD34.2 M in healthcare cost savings). CONCLUSIONS: Exploratory analysis suggests that an intervention to increase fuel excise taxation may deliver obesity and physical activity related benefits. Whilst such an intervention has significant potential for cost-effectiveness,potential equity and acceptability impacts would need to be minimised. A better understanding of the effectiveness and cost-effectiveness of a range of transport interventions is required in order to achieve more physically active transport environments.","BMC Public Health 17(Number): 359","Australia",2017,"Various","Unspecified","HALY","Any","CEA","SLR","Australia","Any","Various","Unspecified","CEA","SLR",null,"2017:2018"]
[11,"Burn,E.,et al. (2015). \"The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: a Markov model informed by a randomised controlled trial.\" BMJ Open 5(4): e007226.",null,"Burn,E.,et al.","The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: a Markov model informed by a randomised controlled trial","OBJECTIVES: To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active,primarily through the use of personalised SMS text-messages. DESIGN: A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. SETTING: This study considers the cost-effectiveness of MobileMums in Queensland,Australia. PARTICIPANTS: A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland,Australia. DATA SOURCES: The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort,treatment effects and resource utilisation were all informed by this trial. MAIN OUTCOME MEASURES: The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. RESULTS: The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. CONCLUSIONS: At a cost-effectiveness threshold of 64 000 AUD,MobileMums would likely be a cost-effective use of healthcare resources in Queensland,Australia. TRIAL REGISTRATION NUMBER: Australian Clinical Trials Registry; ACTRN12611000481976.","BMJ Open 5(Number): e007226","Australia",2015,"None","Unspecified",null,"Adults","CUA","RCT","Australia","Adults","None","Unspecified","CUA","RCT",null,"2015:2015"]
[12,"Campbell,F.,et al. (2015). \"A systematic review and economic evaluation of exercise referral schemes in primary care: a short report.\" Health Technol Assess 19(60): 1-110.",null,"Campbell,F.,et al.","A systematic review and economic evaluation of exercise referral schemes in primary care: a short report","BACKGROUND: It is estimated that only 39% of men and 29% of women in England achieve the levels of physical activity that are recommended to protect health and prevent disease. One approach to addressing this problem has been the development of exercise referral schemes (ERSs),in which health professionals refer patients to external exercise providers. These schemes have been widely rolled out across the UK despite concerns that they may not produce sustained changes in levels of physical activity and,therefore,may not be cost-effective interventions. The evidence to determine clinical effectiveness and cost-effectiveness was evaluated in 2009. This review seeks to update this earlier work by incorporating new evidence and re-examining the cost-effectiveness. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of ERSs compared with usual care. DESIGN: Exhaustive searches of relevant electronic databases and journals were undertaken to identify new studies evaluating ERSs using a randomised controlled trial (RCT) design. RCTs that incorporated a qualitative evaluation of the intervention were identified in order to explore the barriers and facilitators to the uptake of and adherence to ERSs. Data were extracted using a previously designed tool and study quality assessed for potential bias. Where data could be pooled,meta-analyses were carried out. Qualitative analysis was also undertaken using a thematic approach. The cost-effectiveness was evaluated using a Markov structure which estimated the likelihood of becoming physically active and the subsequent risk reduction on coronary heart disease (CHD),stroke and type 2 diabetes mellitus. The model adopts a lifetime horizon,and a NHS and Personal Social Services perspective was taken with discounting at 1.5% for both costs and benefits. RESULTS: The search identified one new RCT and one new qualitative study. The new data were pooled with existing data from the 2011 review by Pavey et al. [Pavey TG,Anokye N,Taylor AH,Trueman P,Moxham T,Fox KR,et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess 2011;15(44)] to give a total of eight studies with 5190 participants. The proportion of individuals achieving 90-150 minutes of at least moderate-intensity activity per week at 6-12 months' follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). Older patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. Exercise referral gained 0.003 quality-adjusted life-years (QALYs) at an additional cost of pound225 per person. The estimated mean incremental cost-effectiveness ratio (ICER) in the probabilistic sensitivity analysis was pound76,276. In the univariate sensitivity analysis the results were very sensitive (ICERs ranged from < pound30,000 to > pound100,000) to changes in the effect of ERSs on physical activity uptake and the duration of the protective effects and the direct health-related quality-of-life gains attributable to physical activity. CONCLUSIONS: Exercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. The cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around pound76,000 per QALY,although the cost-effectiveness of ERSs is subject to considerable uncertainty. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005200. FUNDING: National Institute for Health Research Health Technology Assessment programme.","Health Technol Assess 19(Number): 1-110","UK",2015,"Various","Unspecified",null,"Adults","CUA","SLR","UK","Adults","Various","Unspecified","CUA","SLR",null,"2015:2015"]
[13,"Carande-Kulis,V.,et al. (2015). \"A cost-benefit analysis of three older adult fall prevention interventions.\" J Safety Res 52: 65-70.",null,"Carande-Kulis,V.,et al.","A cost-benefit analysis of three older adult fall prevention interventions","INTRODUCTION: One out of three persons aged 65 and older falls annually and 20% to 30% of falls result in injury. The purpose of this cost-benefit analysis was to identify community-based fall interventions that were feasible,effective,and provided a positive return on investment (ROI). METHODS: A third-party payer perspective was used to determine the costs and benefits of three effective fall interventions. Intervention effectiveness was based on randomized controlled trial results. National data were used to estimate the average annual benefits from averting the direct medical costs of a fall. The net benefit and ROI were estimated for each of the interventions. RESULTS: For the Otago Exercise Program delivered to persons aged 65 and older,the net benefit was $121.85 per participant and the ROI was 36% for each dollar invested. For Otago delivered to persons aged 80 and older,the net benefit was $429.18 and the ROI was 127%. Tai chi: Moving for Better Balance had a net benefit of $529.86 and an ROI of 509% and Stepping On had a net benefit of $134.37 and an ROI of 64%. CONCLUSIONS: All three fall interventions provided positive net benefits. The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs. These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment.","J Safety Res 52(Number): 65-70","USA",2015,"Various","Unspecified",null,"Elderly","CBA","RCT","USA","Elderly","Various","Unspecified","CBA","RCT",null,"2015:2015"]
[14,"Cheng,Q.,et al. (2016). \"Cost-effectiveness of a Population-based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Non-attenders of Cardiac Rehabilitation.\" Heart Lung Circ 25(3): 265-274.",null,"Cheng,Q.,et al.","Cost-effectiveness of a Population-based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Non-attenders of Cardiac Rehabilitation","BACKGROUND: To evaluate the long-term cost-effectiveness of two home-based cardiac rehabilitation (CR) interventions (Healthy Weight (HW) and Physical Activity (PA)) for patients with cardiovascular disease (CVD),who had been referred to cardiac rehabilitation (CR) but had not attended. The interventions consisted of pedometer-based telephone coaching sessions on weight,nutrition and physical activity (HW group) or physical activity only (PA group) and were compared to a control group who received information brochures about physical activity. METHODS: A cost-effectiveness analysis was conducted using data from two randomised controlled trials. One trial compared HW to PA (PANACHE study),and the second compared PA to usual care. A Markov model was developed which used one risk factor,body mass index (BMI) to determine the CVD risk level and mortality. Patient-level data from the trials were used to determine the transitions to CVD states and healthcare related costs. The model was run for separate cohorts of males and females. Univariate and probabilistic sensitivity analysis were conducted to test the robustness of the results. RESULTS: Given a willingness-to-pay threshold of $50,000/QALY,in the long run,both the HW and PA interventions are cost-effective compared with usual care. While the HW intervention is more effective,it also costs more than both the PA intervention and the control group due to higher intervention costs. However,the HW intervention is still cost-effective relative to the PA intervention for both men and women. Sensitivity analysis suggests that the results are robust. CONCLUSION: The results of this paper provide evidence of the long-term cost-effectiveness of home-based CR interventions for patients who are referred to CR but do not attend. Both the HW and PA interventions can be recommended as cost-effective home-based CR programs,especially for people lacking access to hospital services or who are unable to participate in traditional CR programs.","Heart Lung Circ 25(Number): 265-274","UK,Australia",2016,"Cardiovascular","Unspecified",null,"Unspecified","CUA","RCT","UK,Australia","Unspecified","Cardiovascular","Unspecified","CUA","RCT",null,"2016:2016"]
[15,"Clarkson,P.,et al. (2017). \"A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia.\" Value Health 20(8): 1198-1209.",null,"Clarkson,P.,et al.","A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia","BACKGROUND: Recent evidence signals the need for effective forms of home support to people with dementia and their carers. The cost-effectiveness evidence of different approaches to support is scant. OBJECTIVES: To appraise economic evidence on the cost-effectiveness of home support interventions for dementia to inform future evaluation. METHODS: A systematic literature review of full and partial economic evaluations was performed using the British National Health Service Economic Evaluation Database supplemented by additional references. Study characteristics and findings,including incremental cost-effectiveness ratios,when available,were summarized narratively. Study quality was appraised using the National Health Service Economic Evaluation Database critical appraisal criteria and independent ratings,agreed by two reviewers. Studies were located on a permutation matrix describing their mix of incremental costs/effects to aid decision making. RESULTS: Of the 151 articles retrieved,14 studies met the inclusion criteria: 8 concerning support to people with dementia and 6 to carers. Five studies were incremental cost-utility analyses,seven were cost-effectiveness analyses,and two were cost consequences analyses. Five studies expressed incremental cost-effectiveness ratios as cost per quality-adjusted life-year ( pound6,696- pound207,942 per quality-adjusted life-year). In four studies,interventions were dominant over usual care. Two interventions were more costly but more beneficial and were favorable against current acceptability thresholds. CONCLUSIONS: Occupational therapy,home-based exercise,and a carers' coping intervention emerged as cost-effective approaches for which there was better evidence. These interventions used environmental modifications,behavior management,physical activity,and emotional support as active components. More robust evidence is needed to judge the value of these and other interventions across the dementia care pathway.","Value Health 20(Number): 1198-1209","International",2017,"Dementia","Multiple",null,"Elderly","CUA,CEA,CCA","SLR","International","Elderly","Dementia","Multiple","CUA,CEA,CCA","SLR",null,"2017:2018"]
[16,"Cockayne,S.,et al. (2017). \"Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial).\" Health Technol Assess 21(24): 1-198.",null,"Cockayne,S.,et al.","Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial)","BACKGROUND: Falls are a serious cause of morbidity and cost to individuals and society. Evidence suggests that foot problems and inappropriate footwear may increase the risk of falling. Podiatric interventions could help reduce falls; however,there is limited evidence regarding their clinical effectiveness and cost-effectiveness. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for preventing falls in community-dwelling older people at risk of falling,relative to usual care. DESIGN: A pragmatic,multicentred,cohort randomised controlled trial with an economic evaluation and qualitative study. SETTING: Nine NHS trusts in the UK and one site in Ireland. PARTICIPANTS: In total,1010 participants aged >/= 65 years were randomised (intervention,n = 493; usual care,n = 517) via a secure,remote service. Blinding was not possible. INTERVENTIONS: All participants received a falls prevention leaflet and routine care from their podiatrist and general practitioner. The intervention also consisted of footwear advice,footwear provision if required,foot orthoses and foot- and ankle-strengthening exercises. MAIN OUTCOME MEASURES: The primary outcome was the incidence rate of falls per participant in the 12 months following randomisation. The secondary outcomes included the proportion of fallers and multiple fallers,time to first fall,fear of falling,fracture rate,health-related quality of life (HRQoL) and cost-effectiveness. RESULTS: The primary analysis consisted of 484 (98.2%) intervention and 507 (98.1%) usual-care participants. There was a non-statistically significant reduction in the incidence rate of falls in the intervention group [adjusted incidence rate ratio 0.88,95% confidence interval (CI) 0.73 to 1.05; p = 0.16]. The proportion of participants experiencing a fall was lower (50% vs. 55%,adjusted odds ratio 0.78,95% CI 0.60 to 1.00; p = 0.05). No differences were observed in key secondary outcomes. No serious,unexpected and related adverse events were reported. The intervention costs pound252.17 more per participant (95% CI - pound69.48 to pound589.38) than usual care,was marginally more beneficial in terms of HRQoL measured via the EuroQoL-5 Dimensions [mean quality-adjusted life-year (QALY) difference 0.0129,95% CI -0.0050 to 0.0314 QALYs] and had a 65% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of pound30,000 per QALY gained. The intervention was generally acceptable to podiatrists and trial participants. LIMITATIONS: Owing to the difficulty in calculating a sample size for a count outcome,the sample size was based on detecting a difference in the proportion of participants experiencing at least one fall,and not the primary outcome. We are therefore unable to confirm if the trial was sufficiently powered for the primary outcome. The findings are not generalisable to patients who are not receiving podiatry care. CONCLUSIONS: The intervention was safe and potentially effective. Although the primary outcome measure did not reach significance,a lower fall rate was observed in the intervention group. The reduction in the proportion of older adults who experienced a fall was of borderline statistical significance. The economic evaluation suggests that the intervention could be cost-effective. FUTURE WORK: Further research could examine whether or not the intervention could be delivered in group sessions,by physiotherapists,or in high-risk patients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN68240461. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21,No. 24. See the NIHR Journals Library website for further project information.","Health Technol Assess 21(Number): 1-198","UK",2017,"Various","Unspecified",null,"Elderly","CUA","RCT","UK","Elderly","Various","Unspecified","CUA","RCT",null,"2017:2018"]
[17,"Cohen,D.,et al. (2016). \"CicLAvia: Evaluation of participation,physical activity and cost of an open streets event in Los Angeles.\" Prev Med 90: 26-33.",null,"Cohen,D.,et al.","CicLAvia: Evaluation of participation,physical activity and cost of an open streets event in Los Angeles","Physical activity is beneficial for health,but there are limited opportunities in urban areas to safely access public streets for traffic-free cycling,skating or walking. Ciclovias are open streets programs that close major roads to motor vehicles so they can be exclusively used by bicyclists and pedestrians. We estimated participation in one Los Angeles Ciclovia event (CicLAvia) using intercept surveys and 14 surveillance cameras which were placed along the 6-mile route in April 2014. We also applied estimates of the distance and speed traveled from the use of GPS data acquired from subsequent CicLAvia events. CicLAvia attracted between 37,700 and 53,950 active participants generating 176,500 to 263,000 MET-hours of energy expenditure,at an estimated cost borne by tax dollars of $1.29 to $1.91 per MET-hour. Among participants,37% had never previously participated in CicLAvia,but 40% of individuals said that if they were not at CicLAvia they would have been physically active elsewhere and 45% would have been sedentary. Given its large reach,it makes sense to increase the frequency of Ciclovias to occur more than a few times a year to promote population health.","Prev Med 90(Number): 26-33","USA",2016,"None","Cycling,Walking",null,"Any","CEA","Cohort","USA","Any","None","Cycling,Walking","CEA","Cohort",null,"2016:2016"]
[18,"Cowper,P. A.,et al. (2017). \"Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial.\" J Am Geriatr Soc 65(3): 533-539.",null,"Cowper,P. A.,et al.","Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial","OBJECTIVES: To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans. DESIGN: Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance,physical activity,function,disability,and medical resource use and cost. SETTING: Veterans Affairs Medical Center,Durham,North Carolina. PARTICIPANTS: Male veterans aged >/=70 years (n = 398). INTERVENTION: An experienced health counselor provided baseline in-person exercise counseling,followed by telephone counseling at 2,4,and 6 weeks,and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention,followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly. MEASUREMENTS: Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated. RESULTS: The total direct cost of the intervention per participant was $459,85% of which was counselor effort. With overhead,program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention,versus $12,052 with usual care (difference = -$1,634 (95% confidence interval = -$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes,the intervention cost $4,971 per additional patient reaching target exercise levels,or $4,640 per patient achieving a clinically significant change in rapid gait speed. CONCLUSION: Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.","J Am Geriatr Soc 65(Number): 533-539","USA",2017,"None","Unspecified",null,"Elderly","CEA","RCT","USA","Elderly","None","Unspecified","CEA","RCT",null,"2017:2018"]
[19,"Cradock,A. L.,et al. (2017). \"Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood.\" Prev Med 95 Suppl: S17-s27.",null,"Cradock,A. L.,et al.","Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood","Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives,we simulate the national implementation,impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school,afterschool and childcare settings. In 2016,the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day,intervention reach and cost per person,cost per MET-hour change,ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity,including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.","Prev Med 95 Suppl(Number): S17-s27","USA",2017,"None","Unspecified",null,"Children","CEA","SLR","USA","Children","None","Unspecified","CEA","SLR",null,"2017:2018"]
[20,"D'Amico,F.,et al. (2016). \"Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial.\" Int J Geriatr Psychiatry 31(6): 656-665.",null,"D'Amico,F.,et al.","Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial","OBJECTIVE: Although available evidence is modest,exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. We aim to evaluate the cost-effectiveness of a dyadic exercise regimen for individuals with dementia and their main carer as therapy for behavioural and psychological symptoms of dementia. METHODS: Cost-effectiveness analysis within a two-arm,pragmatic,randomised,controlled,single-blind,parallel-group trial of a dyadic exercise regimen (individually tailored,for 20-30 min at least five times per week). The study randomised 131 community-dwelling individuals with dementia and clinically significant behavioural and psychological symptoms with a carer willing and able to participate in the exercise regimen; 52 dyads provided sufficient cost data for analyses. RESULTS: Mean intervention cost was pound284 per dyad. For the subsample of 52 dyads,the intervention group had significantly higher mean cost from a societal perspective (mean difference pound2728.60,p = 0.05),but costs were not significantly different from a health and social care perspective. The exercise intervention was more cost-effective than treatment as usual from both societal and health and social care perspectives for the measure of behavioural and psychological symptoms (Neuropsychiatric Inventory). It does not appear cost-effective in terms of cost per quality-adjusted life year gain. CONCLUSIONS: The exercise intervention has the potential to be seen as cost-effective when considering behavioural and psychological symptoms but did not appear cost-effective when considering quality-adjusted life year gains.","Int J Geriatr Psychiatry 31(Number): 656-665","UK",2016,"Dementia","Multiple",null,"Elderly","CUA,CEA","RCT","UK","Elderly","Dementia","Multiple","CUA,CEA","RCT",null,"2016:2016"]
[21,"Dang,W.,et al. (2017). \"Cost-Effectiveness of Multidisciplinary Management Program and Exercise Training Program in Heart Failure.\" Am J Cardiol 120(8): 1338-1343.",null,"Dang,W.,et al.","Cost-Effectiveness of Multidisciplinary Management Program and Exercise Training Program in Heart Failure","Heart failure causes significant health and financial burdens for patients and society. Multidisciplinary management program (MMP) and exercise training program (ETP) have been reported as cost-effective in improving health outcomes,yet no study has compared the 2 programs. We constructed a Markov model to simulate life year (LY) gained and total costs in usual care (UC),MMP,and ETP. The probability of transitions between states and healthcare costs were extracted from previous literature. We calculated the incremental cost-effectiveness ratio (ICER) over a 10-year horizon. Model robustness was assessed through 1-way and probabilistic sensitivity analyses. The expected LY for patients treated with UC,MMP,and ETP was 7.6,8.2,and 8.4 years,respectively. From a societal perspective,the expected cost of MMP was $20,695,slightly higher than the cost of UC ($20,092). The cost of ETP was much higher ($48,378) because of its high implementation expense and the wage loss it incurred. The ICER of MMP versus UC was $976 per LY gained,and the ICER of ETP versus MMP was $165,702 per LY gained. The results indicated that,under current cost-effectiveness threshold,MMP is cost-effective compared with UC,and ETP is not cost-effective compared with MMP. However,ETP is cost-effective compared with MMP from a healthcare payer's perspective.","Am J Cardiol 120(Number): 1338-1343","USA",2017,"Cardiovascular","Unspecified",null,"Any","CEA","SLR","USA","Any","Cardiovascular","Unspecified","CEA","SLR",null,"2017:2018"]
[22,"Davis,J. C.,et al. (2015). \"Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia.\" Br J Sports Med 49(20): 1343-1347.",null,"Davis,J. C.,et al.","Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia","BACKGROUND: Cognitive decline is one of the most prominent healthcare issues of the 21st century. Within the context of combating cognitive decline through behavioural interventions,physical activity is a promising approach. There is a dearth of health economic data in the area of behavioural interventions for dementia prevention. Yet,economic evaluations are essential for providing information to policy makers for resource allocation. It is essential we first address population and intervention-specific methodological challenges prior to building a larger evidence base. We use a cost-utility analysis conducted alongside the exercise for cognition and everyday living (EXCEL) study to illustrate methodological challenges specific to assessing the cost-effectiveness of behavioural interventions aimed at older adults at risk of cognitive decline. METHODS: A cost-utility analysis conducted concurrently with a 6-month,three-arm randomised controlled trial (ie,the EXCEL study) was used as an example to identify and discuss methodological challenges. RESULTS: Both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. In critically evaluating the economic evaluation of the EXCEL study we identified four category-specific challenges: (1) analysing costs; (2) assessing quality-adjusted life-years; (3) Incomplete data; and (4) 'Intervention' activities of the control group. CONCLUSIONS: Resistance training and aerobic training resulted in healthcare cost saving and were equally effective to balance and tone classes after only 6 months of intervention. To ensure this population is treated fairly in terms of claims on resources,we first need to identify areas for methodological improvement.","Br J Sports Med 49(Number): 1343-1347","Canada",2015,"Dementia","Multiple",null,"Elderly","CUA","RCT","Canada","Elderly","Dementia","Multiple","CUA","RCT",null,"2015:2015"]
[23,"Davis,J. C.,et al. (2017). \"Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial.\" BMJ Open 7(3): e014387.",null,"Davis,J. C.,et al.","Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial","BACKGROUND/OBJECTIVES: Evidence suggests that aerobic exercise may slow the progression of subcortical ischaemic vascular cognitive impairment (SIVCI) by modifying cardiovascular risk factors. Yet the economic consequences relating to aerobic training (AT) remain unknown. Therefore,our primary objective was to estimate the incremental cost per quality-adjusted life years (QALYs) gained of a thrice weekly AT intervention compared with usual care. DESIGN: Cost-utility analysis alongside a randomised trial. SETTING: Vancouver,British Columbia,Canada. PARTICIPANTS: 70 adults (mean age of 74 years,51% women) who meet the diagnostic criteria for mild SIVCI. INTERVENTION: A 6-month,thrice weekly,progressive aerobic exercise training programme compared with usual care (CON; comparator) with a follow-up assessment 6 months after formal cessation of aerobic exercise training. MEASUREMENTS: Healthcare resource usage was estimated over the 6-month intervention and 6-month follow-up period. Health status (using the EQ-5D-3L) at baseline and trial completion and 6-month follow-up was used to calculate QALYs. The incremental cost-utility ratio (cost per QALY gained) was calculated. RESULTS: QALYs were both modestly greater,indicating a health gain. Total healthcare costs (ie,1791+/-1369 {2015 $CAD} at 6 months) were greater,indicating a greater cost for the thrice weekly AT group compared with CON. From the Canadian healthcare system perspective,the incremental cost-utility ratios for thrice weekly AT were cost-effective compared with CON,when using a willingness to pay threshold of $CAD 20 000 per QALY gained or higher. CONCLUSIONS: AT represents an attractive and potentially cost-effective strategy for older adults with mild SIVCI. TRIAL REGISTRATION NUMBER: NCT01027858.","BMJ Open 7(Number): e014387","Canada",2017,"Dementia","Aerobic Training",null,"Elderly","CUA","RCT","Canada","Elderly","Dementia","Aerobic Training","CUA","RCT",null,"2017:2018"]
[24,"Farag,I.,et al. (2015). \"Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization.\" J Am Med Dir Assoc 16(6): 490-496.",null,"Farag,I.,et al.","Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization","BACKGROUND: Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. OBJECTIVE: To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. METHOD: An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60 years and older,with a recent hospital admission,were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery),per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. RESULTS: The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility,$A19,020 per extra person indicating an improvement in health,and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes. CONCLUSION: The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup.","J Am Med Dir Assoc 16(Number): 490-496","Australia",2015,"Unspecified","Unspecified",null,"Elderly","CEA,CUA","RCT","Australia","Elderly","Unspecified","Unspecified","CEA,CUA","RCT",null,"2015:2015"]
[25,"Farag,I.,et al. (2016). \"Economic evaluation of a falls prevention exercise program among people With Parkinson's disease.\" Mov Disord 31(1): 53-61.",null,"Farag,I.,et al.","Economic evaluation of a falls prevention exercise program among people With Parkinson's disease","OBJECTIVE: The aim of this study was to determine the cost-effectiveness of a 6-month minimally supervised exercise program for people with PD. METHODS: An economic analysis was conducted alongside a randomized,controlled trial in which 231 people age 40 years and over with PD were randomized into a usual care control group or an exercise group. Cost-effectiveness was estimated using incremental cost per fall prevented (using falls calendars) as the primary analysis and cost per extra person avoiding mobility deterioration (defined as an improvement or no change in the 12-point Short Physical Performance Battery Score between baseline and 6 month). A cost-utility analysis using the Short Form-6D was also performed. Uncertainty was represented using cost-effectiveness scatter plots and acceptability curves. Planned subgroup analyses for the low-disease-severity group were also undertaken. RESULTS: All results are reported in Australian dollars ($A). The average cost of the intervention was $A1,010 per participant. Incremental cost-effectiveness of the program relative to usual care was $A574 per fall prevented,$A9,570 per extra person avoiding mobility deterioration,and $A338,800 per quality-adjusted life year gained. The intervention had an 80% probability of being cost-effective,relative to the control,at a threshold of $A2,000 per fall prevented. Subgroup analyses for the low-disease-severity group indicate the program to be dominant,that is,less costly and more effective than usual care for all health outcomes. CONCLUSION: The exercise intervention appeared cost-effective with regard to fall prevention in the whole sample and cost saving in the low disease severity group,when compared with usual care.","Mov Disord 31(Number): 53-61","Australia",2016,"Neuromuscular","Unspecified",null,"Adults","CEA,CUA","RCT","Australia","Adults","Neuromuscular","Unspecified","CEA,CUA","RCT",null,"2016:2016"]
[26,"Fernandes,L.,et al. (2017). \"Supervised neuromuscular exercise prior to hip and knee replacement: 12-month clinical effect and cost-utility analysis alongside a randomised controlled trial.\" BMC Musculoskelet Disord 18(1): 5.",null,"Fernandes,L.,et al.","Supervised neuromuscular exercise prior to hip and knee replacement: 12-month clinical effect and cost-utility analysis alongside a randomised controlled trial","BACKGROUND: There are indications of beneficial short-term effect of pre-operative exercise in reducing pain and improving activity of daily living after total hip replacement (THR) and total knee replacement (TKR) surgery. Though,information from studies conducting longer follow-ups and economic evaluations of exercise prior to THR and TKR is needed. The aim of the study was to analyse 12-month clinical effect and cost-utility of supervised neuromuscular exercise prior to THR and TKR surgery. METHODS: The study was conducted alongside a randomised controlled trial including 165 patients scheduled for standard THR or TKR at a hospital located in a rural area of Denmark. The patients were randomised to replacement surgery with or without an 8-week preoperative supervised neuromuscular exercise program (Clinical Trials registration no.: NCT01003756). Clinical effect was measured with Hip disability and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Quality adjusted life years (QALYs) were based on EQ-5D-3L and Danish preference weights. Resource use was extracted from national registries and valued using standard tariffs (2012-EUR). Incremental net benefit was analysed to estimate the probability for the intervention being cost effective for a range of threshold values. A health care sector perspective was applied. RESULTS: HOOS/KOOS quality of life [8.25 (95% CI,0.42 to 16.10)] and QALYs [0.04 (95% CI,0.01 to 0.07)] were statistically significantly improved. Effect-sizes ranged between 0.09-0.59 for HOOS/KOOS subscales. Despite including an intervention cost of euro326 per patient,there was no difference in total cost between groups [euro132 (95% CI -3942 to 3679)]. At a threshold of euro40,000,preoperative exercise was found to be cost effective at 84% probability. CONCLUSION: Preoperative supervised neuromuscular exercise for 8 weeks was found to be cost-effective in patients scheduled for THR and TKR surgery at conventional thresholds for willingness to pay. One-year clinical effects were small to moderate and favoured the intervention group,but only statistically significant for quality of life measures. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01003756 ) October 28,2009.","BMC Musculoskelet Disord 18(Number): 5","Denmark",2017,"Musculoskeletal","Unspecified",null,"Unspecified","CUA","RCT","Denmark","Unspecified","Musculoskeletal","Unspecified","CUA","RCT",null,"2017:2018"]
[27,"Gc,V.,et al. (2016). \"Are brief interventions to increase physical activity cost-effective? A systematic review.\" Br J Sports Med 50(7): 408-417.",null,"Gc,V.,et al.","Are brief interventions to increase physical activity cost-effective? A systematic review","OBJECTIVE: To determine whether brief interventions promoting physical activity are cost-effective in primary care or community settings. DESIGN: Systematic review of economic evaluations. METHODS AND DATA SOURCES: We searched MEDLINE,EMBASE,PsycINFO,CINAHL,EconLit,SPORTDiscus,PEDro,the Cochrane library,National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry up to 20 August 2014. Web of Knowledge was used for cross-reference search. We included studies investigating the cost-effectiveness of brief interventions,as defined by National Institute for Health and Care Excellence,promoting physical activity in primary care or the community. Methodological quality was assessed using Drummond's checklist for economic evaluations. Data were extracted from individual studies fulfilling selection criteria using a standardised pro forma. Comparisons of cost-effectiveness and cost-utility ratios were made between studies. RESULTS: Of 1840 identified publications,13 studies fulfilled the inclusion criteria describing 14 brief interventions. Studies varied widely in the methods used,such as the perspective of economic analysis,intervention effects and outcome measures. The incremental cost of moving an inactive person to an active state,estimated for eight studies,ranged from pound96 to pound986. The cost-utility was estimated in nine studies compared with usual care and varied from pound57 to pound14 002 per quality-adjusted life year; dominant to pound6500 per disability-adjusted life year; and pound15 873 per life years gained. CONCLUSIONS: Brief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care. Given the commonly accepted thresholds,they appear to be cost-effective on the whole,although there is notable variation between studies.","Br J Sports Med 50(Number): 408-417","UK",2016,"Unspecified","Unspecified",null,"Unspecified","CEA,CUA","SLR","UK","Unspecified","Unspecified","Unspecified","CEA,CUA","SLR",null,"2016:2016"]
[28,"Gc,V. S.,et al. (2018). \"Cost-Effectiveness and Value of Information Analysis of Brief Interventions to Promote Physical Activity in Primary Care.\" Value Health 21(1): 18-26.",null,"Gc,V. S.,et al.","Cost-Effectiveness and Value of Information Analysis of Brief Interventions to Promote Physical Activity in Primary Care","BACKGROUND: Brief interventions (BIs) delivered in primary care have shown potential to increase physical activity levels and may be cost-effective,at least in the short-term,when compared with usual care. Nevertheless,there is limited evidence on their longer term costs and health benefits. OBJECTIVES: To estimate the cost-effectiveness of BIs to promote physical activity in primary care and to guide future research priorities using value of information analysis. METHODS: A decision model was used to compare the cost-effectiveness of three classes of BIs that have been used,or could be used,to promote physical activity in primary care: 1) pedometer interventions,2) advice/counseling on physical activity,and (3) action planning interventions. Published risk equations and data from the available literature or routine data sources were used to inform model parameters. Uncertainty was investigated with probabilistic sensitivity analysis,and value of information analysis was conducted to estimate the value of undertaking further research. RESULTS: In the base-case,pedometer interventions yielded the highest expected net benefit at a willingness to pay of pound20,000 per quality-adjusted life-year. There was,however,a great deal of decision uncertainty: the expected value of perfect information surrounding the decision problem for the National Health Service Health Check population was estimated at pound1.85 billion. CONCLUSIONS: Our analysis suggests that the use of pedometer BIs is the most cost-effective strategy to promote physical activity in primary care,and that there is potential value in further research into the cost-effectiveness of brief (i.e.,<30 minutes) and very brief (i.e.,<5 minutes) pedometer interventions in this setting.","Value Health 21(Number): 18-26","UK",2018,"Unspecified","Walking",null,"Unspecified","CUA","SLR","UK","Unspecified","Unspecified","Walking","CUA","SLR",null,"2017:2018"]
[29,"Goode,A. D.,et al. (2015). \"Telephone,print,and Web-based interventions for physical activity,diet,and weight control among cancer survivors: a systematic review.\" J Cancer Surviv 9(4): 660-682.",null,"Goode,A. D.,et al.","Telephone,print,and Web-based interventions for physical activity,diet,and weight control among cancer survivors: a systematic review","PURPOSE: Broad-reach (non-face-to-face) modalities offer an accessible and cost-effective means to provide behavior change programs in diverse and growing cancer survivor populations. The purpose of this systematic review is to evaluate the efficacy of physical activity,dietary,and/or weight control interventions for cancer survivors in which telephone,short-message service,print,and/or Web is the primary method of delivery. METHODS: A structured search of PubMed,Embase,Web of Science,CINAHL,and CENTRAL (May 2013) was conducted. Included studies focused and reported on physical activity (PA) and dietary change and/or weight control in adult cancer survivors,delivered at least 50% of intervention contacts by broad-reach modality and included a control group. Study design,intervention features,and behavioral/weight outcomes were extracted,tabulated,and summarized. RESULTS: Twenty-seven studies were included; 22 telephone,three Web,and two print. Sixteen studies targeted PA,two diet,and nine targeted multiple behaviors. Most studies (18/27) targeted a single survivor group,namely breast cancer (n = 12). Nineteen of 27 studies found evidence for initiation of behavior change,with only eight reporting on maintenance and one on cost-effectiveness. CONCLUSIONS: This review provides support for broad-reach modalities,particularly the telephone,in the delivery of lifestyle interventions to cancer survivors. Future research should evaluate (1) newer technologies (i.e.,SMS and mobile phone applications),(2) interventions for diverse cancer survivors and those targeting multiple behaviors,(3) long-term outcomes,and 4) cost-effectiveness. IMPLICATIONS FOR CANCER SURVIVORS: Broad-reach lifestyle interventions are effective,with further research needed to evaluate their generalizability and integration into cancer care.","J Cancer Surviv 9(Number): 660-682","International",2015,"Cancer","Unspecified",null,"Adults","CEA","SLR","International","Adults","Cancer","Unspecified","CEA","SLR",null,"2015:2015"]
[30,"Goranitis,I.,et al. (2017). \"Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial.\" PLoS One 12(9): e0184328.",null,"Goranitis,I.,et al.","Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial","OBJECTIVE: To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms. DESIGN: Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective. SETTING: Primary care. POPULATION: Peri- and postmenopausal women who have not used hormone therapy in the past 3 months and experience >/= 5 episodes of vasomotor symptoms daily. METHODS: An individual and a social support-based exercise intervention were evaluated. The former (Exercise-DVD),aimed to prompt exercise with purpose-designed DVD and written materials,whereas the latter (Exercise-Social support) with community exercise social support groups. Costs and outcomes associated with these interventions were compared to those of a control group,who could only have an exercise consultation. An incremental cost-utility analysis was undertaken using bootstrapping to account for the uncertainty around cost-effectiveness point-estimates. MAIN OUTCOME MEASURE: Cost per quality-adjusted life-year (QALY). RESULTS: Data for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was pound52 (CIs: pound18 to pound86) and pound18 (CIs: - pound68 to pound105) more expensive per woman than the control group at 6 and 12 months post-randomisation and led to 0.006 (CIs: -0.002 to 0.014) and 0.013 (CIs: -0.01 to 0.036) more QALYs,resulting in an incremental cost-effectiveness ratio of pound8,940 and pound1,413 per QALY gained respectively. Exercise-Social support had 80%-90% probability of being cost-effective in the UK context. A societal perspective of analysis and a complete-case analysis led to similar findings. CONCLUSIONS: Exercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms.","PLoS One 12(Number): e0184328","UK",2017,"Various","Home Based Training",null,"Adults","CUA","RCT","UK","Adults","Various","Home Based Training","CUA","RCT",null,"2017:2018"]
[31,"Gordon,L. G.,et al. (2017). \"Cost-effectiveness of a pragmatic exercise intervention for women with breast cancer: results from a randomized controlled trial.\" Psychooncology 26(5): 649-655.",null,"Gordon,L. G.,et al.","Cost-effectiveness of a pragmatic exercise intervention for women with breast cancer: results from a randomized controlled trial","OBJECTIVE: To report on the cost-effectiveness of the Exercise for Health trial,comparing an exercise intervention with usual care during and following treatment for women with breast cancer. METHODS: Women with breast cancer were randomized to an 8-month exercise intervention (involving regular contact with an exercise physiologist over the phone,n = 67,or home delivered face to face,n = 67) or usual care (n = 60) group and were assessed pre-intervention (5 weeks post-surgery),mid-intervention (6 months post-surgery),and 10 weeks post-intervention (12 months post-surgery). The benefit measures were \"number of improvers\" in quality of life (FACT-B+4) and quality-adjusted life years (QALYs). Data on provider,patient,and government costs were used to consider 2 cost scenarios: (1) a service provider model and (2) a private model. RESULTS: There were 69 improvers in the intervention group compared with 21 in the usual care group (odds ratio 2.09,95% confidence interval 1.08,4.01; P = .033). The incremental cost per improver was A$2282 to A$2644. Quality-adjusted life years gain for the intervention group versus the usual care group was 0.009,with incremental cost per QALY gain for models 1 and 2 being A$105 231 and A$90 842,respectively. However,sensitivity analyses indicate that incremental cost per QALY gained was volatile to EuroQol-5D-3L weights. CONCLUSIONS: Findings suggest that a pragmatic exercise intervention yields more women with markedly improved quality of life after breast cancer than usual care and may be cost-effective. The results are less certain in terms of incremental cost per quality-adjusted life years; however,this may be an inappropriate measure for reflecting exercise benefit for women with breast cancer.","Psychooncology 26(Number): 649-655","Australia",2017,"Cancer","Physiotherapy",null,"Adults","CUA","RCT","Australia","Adults","Cancer","Physiotherapy","CUA","RCT",null,"2017:2018"]
[32,"Gordon,L. G.,et al. (2015). \"A telephone-delivered multiple health behaviour change intervention for colorectal cancer survivors: making the case for cost-effective healthcare.\" Eur J Cancer Care (Engl) 24(6): 854-861.",null,"Gordon,L. G.,et al.","A telephone-delivered multiple health behaviour change intervention for colorectal cancer survivors: making the case for cost-effective healthcare","UNLABELLED: In patients with colorectal cancer,a trial of a telephone-delivered multiple health behaviour change intervention,using acceptance commitment therapy strategies,found benefits for health and psychosocial outcomes including increased physical activity,improved dietary habits and lower body mass index. Our aim was to address the health economic outcomes by assessing the health system cost and health utility impacts of the intervention. A cost-consequences analysis was performed using data from a two-group randomised controlled intervention trial (n = 410). Outcomes included health-related quality of life (HRQoL),health utility and health system costs. At 12 months,clinically meaningful improvements were found for SF-6D over time but no significant differences were found between groups (P = 0.95). The cost of delivering the 6-month intervention was on average euro280 per person and made up 21% of overall healthcare costs for participants during the intervention period. Excluding intervention costs,costs were similar for health professional visits and medications across groups. Despite significant positive intervention effects on health behaviours,health utility and HRQoL scores were similar across groups. On the basis that intervention costs were small and physical activity,diet and weight management improved,on balance the intervention is potentially a worthwhile investment in healthcare funds. TRIAL REGISTRATION: ACTRN12608000399392.","Eur J Cancer Care (Engl) 24(Number): 854-861","Unclear",2015,"Cancer","Unspecified",null,"Unspecified","CCA","RCT","Unclear","Unspecified","Cancer","Unspecified","CCA","RCT",null,"2015:2015"]
[33,"Gortmaker,S. L.,et al. (2015). \"Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES.\" Am J Prev Med 49(1): 102-111.",null,"Gortmaker,S. L.,et al.","Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES","INTRODUCTION: The childhood obesity epidemic continues in the U.S.,and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However,cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). METHODS: Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness,implementation,and equity issues were reviewed. RESULTS: Population reach varied widely,and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At 10 years,assuming maintenance of the intervention effect,three interventions would save net costs,with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years,and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue. CONCLUSIONS: The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money.","Am J Prev Med 49(Number): 102-111","USA",2015,"Various","Physical Exercise",null,"Children","CEA,CUA","Cohort","USA","Children","Various","Physical Exercise","CEA,CUA","Cohort",null,"2015:2015"]
[34,"Gostin,L. O.,et al. (2017). \"Legal priorities for prevention of non-communicable diseases: innovations from WHO's Eastern Mediterranean region.\" Public Health 144: 4-12.",null,"Gostin,L. O.,et al.","Legal priorities for prevention of non-communicable diseases: innovations from WHO's Eastern Mediterranean region","OBJECTIVES: Non-communicable diseases (NCDs) are the leading cause of death globally and in the World Health Organization's (WHO) Eastern Mediterranean region (EMR). This paper reports on a research collaboration between the WHO's Eastern Mediterranean Office (EMRO) and the O'Neill Institute for National and Global Health Law at Georgetown University that aims to identify (1) regionally relevant,cost-effective and affordable legal interventions to prevent NCDs,and (2) methods to strengthen implementation and enforcement. STUDY DESIGN: Comparative analysis of >200 international,regional and domestic interventions addressing key NCD risk factors,including tobacco,alcohol,diet and physical inactivity. METHODS: Researchers searched legal and policy databases including the WHO Nutrition,Obesity and Physical Activity Database and drew upon academic commentary and 'grey' literature. Measures included evidence of impact; evidence of cost-effectiveness; and monitoring and enforcement mechanisms. RESULTS: Researchers identified many examples of legal interventions effectively reducing NCD risk factors. Key enabling factors for effective NCD-related laws include regulatory capacity; governance mechanisms promoting multisectoral collaboration and accountability; and tailoring interventions to local legal,economic and social contexts. CONCLUSIONS: In the EMR,and globally,law can be a cost-effective and affordable means of curbing underlying drivers of the NCD pandemic,such as rampant junk food marketing. Building upon this research,together with international and regional experts,EMRO has identified 10 priority interventions in the areas of tobacco control,unhealthy diets and NCD governance. The EMRO/O'Neill Institute partnership will develop guidance tools and capacity building initiatives to support Member States to harness the power of law to achieve population health improvements.","Public Health 144(Number): 4-12","Europe",2017,"Various","Unspecified",null,"Unspecified","CEA","SLR","Europe","Unspecified","Various","Unspecified","CEA","SLR",null,"2017:2018"]
[35,"Grande, A. J., et al. (2015). \"Exercise versus no exercise for the occurrence, severity and duration of acute respiratory infections.\" Cochrane Database Syst Rev (6): Cd010596.",null,"Grande, A. J., et al.","Exercise versus no exercise for the occurrence, severity and duration of acute respiratory infections","BACKGROUND: Acute respiratory infections (ARIs) last for less than 30 days and are the most common acute diseases affecting people worldwide. Exercise has been shown to improve health generally and may be effective in reducing the occurrence, severity and duration of acute respiratory infections. OBJECTIVES: To evaluate the effectiveness of exercise for altering the occurrence, severity or duration of acute respiratory infections. SEARCH METHODS: We searched CENTRAL (2014, Issue 6), MEDLINE (1948 to July week 1, 2014), EMBASE (2010 to July 2014), CINAHL (1981 to July 2014), LILACS (1982 to July 2014), SPORTDiscus (1985 to July 2014), PEDro (searched on 11 July 2014), OTseeker (searched on 11 July 2014), the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (searched on 11 July 2014). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of exercise for ARIs in the general population. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from the included trials using a standard form. We contacted trial authors to request missing data. One review author entered data and a second review author checked this. There were sufficient differences in the populations trialled and in the nature of the interventions to use the random-effects model (which makes fewer assumptions than the fixed-effect model) in the analysis. MAIN RESULTS: We included 11 trials involving 904 adults, published between 1990 and 2014. Eight studies were conducted in the USA, and one each in Canada, Spain and Turkey. Sample sizes ranged from 20 to 154 participants aged between 18 and 85 years old. The proportion of female participants varied between 52% and 100%. The duration of follow-up in the studies varied from seven days to 12 months. The exercise type most prescribed for the intervention was aerobic (walking in 70% of the studies, or bicycle riding or treadmill) at least five times a week. Duration was 30 to 45 minutes at moderate intensity. Participants were supervised in 90% of the studies.For four of the primary outcomes the results did not differ significantly and all were low-quality evidence (number of ARI episodes per person per year, rate ratio 0.91 (95% confidence interval (CI) 0.59 to 1.42); proportion of participants who experienced at least one ARI over the study period, risk ratio 0.76 (95% CI 0.57 to 1.01); severity of ARI symptoms, mean difference (MD) -110 (95% CI -324 to 104); and number of symptom days in the follow-up period, MD -2.1 days (95% CI -4.4 to 0.3)). However, one primary outcome, the number of symptom days per episode of illness, was reduced in those participants who exercised (MD -1.1 day, 95% CI -1.7 to -0.5, moderate-quality evidence).We found no significant differences for the secondary outcomes (laboratory parameters (blood lymphocytes, salivary secretory immunoglobulin and neutrophils); quality of life outcomes; cost-effectiveness and exercise-related injuries).There was good adherence to the intervention with no difference between the exercise and non-exercise groups.We rated the quality of evidence for the primary outcomes as low for most outcomes using the GRADE criteria: allocation concealment was not reported and there was a lack of blinding; in addition, there was imprecision (the CI is very wide because of a small number of participants) and inconsistency, which may be due to differences in study design. AUTHORS' CONCLUSIONS: We cannot determine whether exercise is effective at altering the occurrence, severity or duration of acute respiratory infections. One analysis of four trials suggests that the number of days of illness per episode of infection might be reduced by exercise. The small size of the studies, risk of bias and heterogeneous populations trialled all contribute to the uncertainty. Larger studies, with less risk of bias from patient selection, blinding of outcomes assessors, reporting of all outcomes measured and with registration of study protocols, are required to settle the question.","Cochrane Database Syst Rev Cd010596","International",2015,"Respiratory","Walking",null,"Adults","CEA","SLR","International","Adults","Respiratory","Walking","CEA","SLR",null,"2015:2015"]
[36,"Groessl, E. J., et al. (2016). \"Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability.\" J Gerontol A Biol Sci Med Sci 71(5): 656-662.",null,"Groessl, E. J., et al.","Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability","BACKGROUND: Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention. METHODS: The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2x weekly, augmented with home-based activity to achieve a goal of 150 min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon. RESULTS: The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions. CONCLUSIONS: The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.","J Gerontol A Biol Sci Med Sci 71(Number): 656-662","USA",2016,"Various","Unspecified",null,"Elderly","CUA","RCT","USA","Elderly","Various","Unspecified","CUA","RCT",null,"2016:2016"]
[37,"Haas, M. and R. De Abreu Lourenco (2015). \"Pharmacological management of chronic lower back pain: a review of cost effectiveness.\" Pharmacoeconomics 33(6): 561-569.",null,"Haas, M. and R. De Abreu Lourenco","Pharmacological management of chronic lower back pain: a review of cost effectiveness","Lower back pain is one of the most prevalent musculoskeletal conditions in the developed world and accounts for significant health services use. The American College of Physicians and the American Pain Society have published a joint clinical guideline that recommends providing patients with information on prognosis and self-management, the use of medications with proven benefits and, for those who do not improve, consideration be given to the use of spinal manipulation (for acute lower back pain only), interdisciplinary rehabilitation, exercise, acupuncture, massage, yoga, cognitive behavioural therapy or relaxation. The purpose of this review was to evaluate published economic evaluations of pharmacological management for chronic lower back pain. A total of seven studies were eligible for inclusion in there view. The quality of the economic evaluations undertaken in the included studies was not high. This was primarily because of the nature of the underlying clinical evidence, most of which did not come from rigorous randomised controlled trials (RCTs), and the manner in which it was incorporated into the economic evaluations. All studies provided reasonable information about what aspects of healthcare and other resource use were identified, measured and valued. However, the reporting of total costs was not uniform across studies. Measures of pain and disability were the most commonly collected outcomes measures. Two studies collected information on quality of life directly from participants while two studies modelled this information based on the literature. Future economic evaluations of interventions for chronic lower back pain, including pharmacological interventions, should be based on the results of well-conducted RCTs where the measurement of costs and outcomes such as quality of life and quality-adjusted life-years is included in the trial protocol, and which have a follow-up period sufficient to capture meaningful changes in both costs and outcomes. In the absence of RCT data, economic models should be used to estimate future costs and outcomes using robust methods.","Pharmacoeconomics 33(Number): 561-569","International",2015,"Musculoskeletal","Unspecified",null,"Unspecified","CUA,CEA","SLR","International","Unspecified","Musculoskeletal","Unspecified","CUA,CEA","SLR",null,"2015:2015"]
[38,"Hautala, A. J., et al. (2017). \"Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome.\" Scand J Med Sci Sports 27(11): 1395-1403.",null,"Hautala, A. J., et al.","Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome","Health care decision-making requires evidence of the cost-effectiveness of medical therapies. We evaluated the cost-effectiveness of exercise-based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n = 204) had experienced a recent acute coronary syndrome and were randomized to a 1-year ECR (n = 109) or usual care (UC) group (n = 95). The patients' health-related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost-effectiveness of ECR was estimated based on intervention and health care costs and quality-adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline-adjusted incremental QALYs (0.045), yielding an incremental cost-effectiveness ratio of -euro24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4-10.6, P = 0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision-making when planning optimal utilization of resources in Finnish health care.","Scand J Med Sci Sports 27(Number): 1395-1403","Finland",2017,"Cardiovascular","Unspecified",null,"Unspecified","CUA","Cohort","Finland","Unspecified","Cardiovascular","Unspecified","CUA","Cohort",null,"2017:2018"]
[39,"Johnson, M. J., et al. (2015). \"A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease.\" BMC Med 13: 213.",null,"Johnson, M. J., et al.","A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease","BACKGROUND: About 90 % of patients with intra-thoracic malignancy experience breathlessness. Breathing training is helpful, but it is unknown whether repeated sessions are needed. The present study aims to test whether three sessions are better than one for breathlessness in this population. METHODS: This is a multi-centre randomised controlled non-blinded parallel arm trial. Participants were allocated to three sessions or single (1:2 ratio) using central computer-generated block randomisation by an independent Trials Unit and stratified for centre. The setting was respiratory, oncology or palliative care clinics at eight UK centres. Inclusion criteria were people with intrathoracic cancer and refractory breathlessness, expected prognosis >/=3 months, and no prior experience of breathing training. The trial intervention was a complex breathlessness intervention (breathing training, anxiety management, relaxation, pacing, and prioritisation) delivered over three hour-long sessions at weekly intervals, or during a single hour-long session. The main primary outcome was worst breathlessness over the previous 24 hours ('worst'), by numerical rating scale (0 = none; 10 = worst imaginable). Our primary analysis was area under the curve (AUC) 'worst' from baseline to 4 weeks. All analyses were by intention to treat. RESULTS: Between April 2011 and October 2013, 156 consenting participants were randomised (52 three; 104 single). Overall, the 'worst' score reduced from 6.81 (SD, 1.89) to 5.84 (2.39). Primary analysis [n = 124 (79 %)], showed no between-arm difference in the AUC: three sessions 22.86 (7.12) vs single session 22.58 (7.10); P value = 0.83); mean difference 0.2, 95 % CIs (-2.31 to 2.97). Complete case analysis showed a non-significant reduction in QALYs with three sessions (mean difference -0.006, 95 % CIs -0.018 to 0.006). Sensitivity analyses found similar results. The probability of the single session being cost-effective (threshold value of pound20,000 per QALY) was over 80 %. CONCLUSIONS: There was no evidence that three sessions conferred additional benefits, including cost-effectiveness, over one. A single session of breathing training seems appropriate and minimises patient burden. TRIAL REGISTRATION: Registry: ISRCTN; TRIAL REGISTRATION NUMBER: ISRCTN49387307; http://www.isrctn.com/ISRCTN49387307 ; registration date: 25/01/2011.","BMC Med 13(Number): 213","UK",2015,"Cancer","Breathing Techniques",null,"Unspecified","CUA","RCT","UK","Unspecified","Cancer","Breathing Techniques","CUA","RCT",null,"2015:2015"]
[40,"Johnson, T. J., et al. (2016). \"The Cost of Increasing Physical Activity and Maintaining Weight for Midlife Sedentary African American Women.\" Value Health 19(1): 20-27.",null,"Johnson, T. J., et al.","The Cost of Increasing Physical Activity and Maintaining Weight for Midlife Sedentary African American Women","OBJECTIVE: To evaluate the marginal costs of increasing physical activity and maintaining weight for a lifestyle physical activity program targeting sedentary African American women. METHODS: Outcomes included change in minutes of total moderate to vigorous physical activity, leisure-time moderate to vigorous physical activity and walking per week, and weight stability between baseline and maintenance at 48 weeks. Marginal cost-effectiveness ratios (MCERs) were calculated for each outcome, and 95% confidence intervals (CIs) were computed using a bootstrap method. The analysis was carried out from the societal perspective and calculated in 2013 US dollars. RESULTS: For the 260 participants in the analysis, program costs were $165 +/- $19, and participant costs were $164 +/- $35, for a total cost of $329 +/- $49. The MCER for change in walking was $1.50/min/wk (95% CI 1.28-1.87), for change in moderate to vigorous physical activity was $1.73/min/wk (95% CI 1.41-2.18), and for leisure-time moderate to vigorous physical activity was $1.94/min/wk (95% CI 1.58-2.40). The MCER for steps based on the accelerometer was $0.46 per step (95% CI 0.30-0.85) and weight stability was $412 (95% CI 399-456). CONCLUSIONS: The Women's Lifestyle Physical Activity Program is a relatively low-cost strategy for increasing physical activity. The marginal cost of increasing physical activity is lower than for weight stability. The participant costs related to time in the program were nearly half the total costs, suggesting that practitioners and policymakers should consider the participant cost when disseminating a lifestyle physical activity program into practice.","Value Health 19(Number): 20-27","USA",2016,"None","Multiple",null,"Adults","CEA","Cohort","USA","Adults","None","Multiple","CEA","Cohort",null,"2016:2016"]
[41,"Jordan, R. E., et al. (2015). \"Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis.\" Health Technol Assess 19(36): 1-516.",null,"Jordan, R. E., et al.","Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis","BACKGROUND: Self-management (SM) support for patients with chronic obstructive pulmonary disease (COPD) is variable in its coverage, content, method and timing of delivery. There is insufficient evidence for which SM interventions are the most effective and cost-effective. OBJECTIVES: To undertake (1) a systematic review of the evidence for the effectiveness of SM interventions commencing within 6 weeks of hospital discharge for an exacerbation for COPD (review 1); (2) a systematic review of the qualitative evidence about patient satisfaction, acceptance and barriers to SM interventions (review 2); (3) a systematic review of the cost-effectiveness of SM support interventions within 6 weeks of hospital discharge for an exacerbation of COPD (review 3); (4) a cost-effectiveness analysis and economic model of post-exacerbation SM support compared with usual care (UC) (economic model); and (5) a wider systematic review of the evidence of the effectiveness of SM support, including interventions (such as pulmonary rehabilitation) in which there are significant components of SM, to identify which components are the most important in reducing exacerbations, hospital admissions/readmissions and improving quality of life (review 4). METHODS: The following electronic databases were searched from inception to May 2012: MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Science Citation Index [Institute of Scientific Information (ISI)]. Subject-specific databases were also searched: PEDro physiotherapy evidence database, PsycINFO and the Cochrane Airways Group Register of Trials. Ongoing studies were sourced through the metaRegister of Current Controlled Trials, International Standard Randomised Controlled Trial Number database, World Health Organization International Clinical Trials Registry Platform Portal and ClinicalTrials.gov. Specialist abstract and conference proceedings were sourced through ISI's Conference Proceedings Citation Index and British Library's Electronic Table of Contents (Zetoc). Hand-searching through European Respiratory Society, the American Thoracic Society and British Thoracic Society conference proceedings from 2010 to 2012 was also undertaken, and selected websites were also examined. Title, abstracts and full texts of potentially relevant studies were scanned by two independent reviewers. Primary studies were included if approximately 90% of the population had COPD, the majority were of at least moderate severity and reported on any intervention that included a SM component or package. Accepted study designs and outcomes differed between the reviews. Risk of bias for randomised controlled trials (RCTs) was assessed using the Cochrane tool. Random-effects meta-analysis was used to combine studies where appropriate. A Markov model, taking a 30-year time horizon, compared a SM intervention immediately following a hospital admission for an acute exacerbation with UC. Incremental costs and quality-adjusted life-years were calculated, with sensitivity analyses. RESULTS: From 13,355 abstracts, 10 RCTs were included for review 1, one study each for reviews 2 and 3, and 174 RCTs for review 4. Available studies were heterogeneous and many were of poor quality. Meta-analysis identified no evidence of benefit of post-discharge SM support on admissions [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.52 to 1.17], mortality (HR 1.07, 95% CI 0.74 to 1.54) and most other health outcomes. A modest improvement in health-related quality of life (HRQoL) was identified but this was possibly biased due to high loss to follow-up. The economic model was speculative due to uncertainty in impact on readmissions. Compared with UC, post-discharge SM support (delivered within 6 weeks of discharge) was more costly and resulted in better outcomes ( pound683 cost difference and 0.0831 QALY gain). Studies assessing the effect of individual components were few but only exercise significantly improved HRQoL (3-month St George's Respiratory Questionnaire 4.87, 95% CI 3.96 to 5.79). Multicomponent interventions produced an improved HRQoL compared with UC (mean difference 6.50, 95% CI 3.62 to 9.39, at 3 months). Results were consistent with a potential reduction in admissions. Interventions with more enhanced care from health-care professionals improved HRQoL and reduced admissions at 1-year follow-up. Interventions that included supervised or unsupervised structured exercise resulted in significant and clinically important improvements in HRQoL up to 6 months. LIMITATIONS: This review was based on a comprehensive search strategy that should have identified most of the relevant studies. The main limitations result from the heterogeneity of studies available and widespread problems with their design and reporting. CONCLUSIONS: There was little evidence of benefit of providing SM support to patients shortly after discharge from hospital, although effects observed were consistent with possible improvement in HRQoL and reduction in hospital admissions. It was not easy to tease out the most effective components of SM support packages, although interventions containing exercise seemed the most effective. Future work should include qualitative studies to explore barriers and facilitators to SM post exacerbation and novel approaches to affect behaviour change, tailored to the individual and their circumstances. Any new trials should be properly designed and conducted, with special attention to reducing loss to follow-up. Individual participant data meta-analysis may help to identify the most effective components of SM interventions. STUDY REGISTRATION: This study is registered as PROSPERO CRD42011001588. FUNDING: The National Institute for Health Research Health Technology Assessment programme.","Health Technol Assess 19(Number): 1-516","UK",2015,"Respiratory","Unspecified",null,"Unspecified","CUA","SLR","UK","Unspecified","Respiratory","Unspecified","CUA","SLR",null,"2015:2015"]
[42,"Kolu, P., et al. (2015). \"Cost-effectiveness of physical activity among women with menopause symptoms: findings from a randomised controlled trial.\" PLoS One 10(8): e0135099.",null,"Kolu, P., et al.","Cost-effectiveness of physical activity among women with menopause symptoms: findings from a randomised controlled trial","Menopause is a period that may predispose one to a decrease in muscle strength, cardiorespiratory fitness, and quality of life. A study was carried out to evaluate the cost-effectiveness of physical activity among women displaying symptoms of menopause. The cost-effectiveness analysis was based on data from a six-month randomised controlled trial (n = 151). The women in the intervention group engaged in an unsupervised session of at least 50 minutes of physical activity four times a week. The control group continued their physical activity as before. An incremental cost-effectiveness ratio (ICER) was calculated in terms of maximal oxygen consumption, lean muscle mass, and quality-adjusted life years (QALYs) gained. A bootstrap technique was utilised to estimate uncertainty around the point estimate for ICER associated with the intervention. The mean total cost in the intervention group was euro1,307 (SEM: euro311) and in the control group was euro1,253 (SEM: euro279, p = 0.10) per person. The mean intervention cost was euro208 per person. After six months of the behaviour-change intervention, the ICER was euro63 for a 1 ml/kg/min improvement in cardiorespiratory fitness, the additional cost per one-gram increase in lean muscle mass was euro126, and the cost per QALY gained was euro46. According to the findings, physical activity among menopausal women was cost-effective for cardiorespiratory fitness, for lean muscle mass, and for QALYs gained, since the intervention was more effective than the actions within the control group and the additional effects of physical activity were gained at a very low price. From the societal perspective, the intervention used may promote ability to work and thereby save on further costs associated with early retirement or disability pension if the physical-activity level remains at least the same as during the intervention.","PLoS One 10(Number): e0135099","Finland",2015,"Various","Unspecified",null,"Unspecified","CUA","RCT","Finland","Unspecified","Various","Unspecified","CUA","RCT",null,"2015:2015"]
[43,"Kolu, P., et al. (2016). \"Effectiveness and Cost-Effectiveness of a Cluster-Randomized Prenatal Lifestyle Counseling Trial: A Seven-Year Follow-Up.\" PLoS One 11(12): e0167759.",null,"Kolu, P., et al.","Effectiveness and Cost-Effectiveness of a Cluster-Randomized Prenatal Lifestyle Counseling Trial: A Seven-Year Follow-Up","There is a link between the pregnancy and its long-term influence on health and susceptibility to future chronic disease both in mother and offspring. The objective was to determine whether individual counseling on physical activity and diet and weight gain at five antenatal visits can prevent type 2 diabetes mellitus (T2DM) and overweight or improve glycemic parameters, among all at-risk-mothers and their children. Another objective was to evaluate whether gestational lifestyle intervention was cost-effective as measured with mother's sickness absence and quality-adjusted life years (QALY). This study was a seven-year follow-up study for women, who were enrolled to the antenatal cluster-randomized controlled trial (RCT). Analysis of the outcome included all women whose outcome was available, in addition with subgroup analysis including women adherent to all lifestyle aims. A total of 173 women with their children participated to the study, representing 43% (173/399) of the women who finished the original RCT. Main outcome measures were: T2DM based on medication use or fasting blood glucose or oral glucose tolerance test (OGTT), body mass index (BMI), glycosylated hemoglobin (HbA1c). None of the women were diagnosed to have T2DM. HbA1c or fasting blood glucose differences were not found among mothers or children. Differences in BMI were non-significant among mothers (Intervention 27.3, Usual care 28.1 kg/m2, p = 0.33) and children (I 21.3 vs U 22.5 kg/m2, p = 0.07). Children's BMI was significantly lower among adherent group (I 20.5 vs U 22.5, p = 0.04). The mean total cost per person was 30.6% lower in the intervention group than in the usual care group (I euro2,944 vs. U euro4,243; p = 0.74). Intervention was cost-effective in terms of sickness absence but not in QALY gained i.e. if society is willing to pay additional euro100 per one avoided sickness absence day; there is a 90% probability of the intervention arm to be cost-effective. Long-term effectiveness of antenatal lifestyle counseling was not shown, in spite of possible effect on children's BMI. Cost-effectiveness of the intervention in terms of sickness absence may have larger societal impact.","PLoS One 11(Number): e0167759","Finland",2016,"None","Unspecified",null,"Children,Adults","CUA,CEA","RCT","Finland","Children,Adults","None","Unspecified","CUA,CEA","RCT",null,"2016:2016"]
[44,"Kraal, J. J., et al. (2017). \"Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study.\" Eur J Prev Cardiol 24(12): 1260-1273.",null,"Kraal, J. J., et al.","Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study","Aim Although cardiac rehabilitation improves physical fitness after a cardiac event, many eligible patients do not participate in cardiac rehabilitation and the beneficial effects of cardiac rehabilitation are often not maintained over time. Home-based training with telemonitoring guidance could improve participation rates and enhance long-term effectiveness. Methods and results We randomised 90 low-to-moderate cardiac risk patients entering cardiac rehabilitation to three months of either home-based training with telemonitoring guidance or centre-based training. Although training adherence was similar between groups, satisfaction was higher in the home-based group ( p = 0.02). Physical fitness improved at discharge ( p < 0.01) and at one-year follow-up ( p < 0.01) in both groups, without differences between groups (home-based p = 0.31 and centre-based p = 0.87). Physical activity levels did not change during the one-year study period (centre-based p = 0.38, home-based p = 0.80). Healthcare costs were statistically non-significantly lower in the home-based group (euro437 per patient, 95% confidence interval -562 to 1436, p = 0.39). From a societal perspective, a statistically non-significant difference of euro3160 per patient in favour of the home-based group was found (95% confidence interval -460 to 6780, p = 0.09) and the probability that it was more cost-effective varied between 97% and 75% (willingness-to-pay of euro0 and euro100,000 per quality-adjusted life-years, respectively). Conclusion We found no differences between home-based training with telemonitoring guidance and centre-based training on physical fitness, physical activity level or health-related quality of life. However, home-based training was associated with a higher patient satisfaction and appears to be more cost-effective than centre-based training. We conclude that home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients entering cardiac rehabilitation.","Eur J Prev Cardiol 24(Number): 1260-1273","Netherlands",2017,"Various","Home Based Training",null,"Unspecified","CUA","RCT","Netherlands","Unspecified","Various","Home Based Training","CUA","RCT",null,"2017:2018"]
[45,"Landen Ludvigsson, M., et al. (2017). \"Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders: Analyses of a randomized clinical trial.\" Medicine (Baltimore) 96(25): e7274.",null,"Landen Ludvigsson, M., et al.","Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders: Analyses of a randomized clinical trial","BACKGROUND: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered. OBJECTIVE: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3. METHODS: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made. RESULTS: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$ 12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower. CONCLUSION: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.","Medicine (Baltimore) 96(Number): e7274","USA",2017,"Musculoskeletal","Physiotherapy",null,"Unspecified","CUA","RCT","USA","Unspecified","Musculoskeletal","Physiotherapy","CUA","RCT",null,"2017:2018"]
[46,"Larsen, B., et al. (2015). \"Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control.\" Int J Behav Nutr Phys Act 12: 140.",null,"Larsen, B., et al.","Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control","BACKGROUND: Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas. METHODS: Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) using the 7-Day Physical Activity Recall Interview. Costs were calculated from a payer perspective, and included personnel time (wage, fringe, and overhead), materials, equipment, software, and postage costs. RESULTS: At six months, the PA intervention cost $29/person/month, compared to $15/person/month for wellness control. These costs fell to $17 and $9 at 12 months, respectively. Intervention participants increased their PA by an average of 72 min/week at six months and 94 min/week at 12 months, while wellness control participants increased their PA by an average of 30 min/week and 40 min/week, respectively. At six months, each minute increase in PA cost $0.18 in the intervention group compared to $0.23 in wellness control, which fell to $0.07 and $0.08 at 12 months, respectively. The incremental cost per increase in physical activity associated with the intervention was $0.15 at 6 months and $0.05 at 12 months. CONCLUSIONS: While the intervention was more costly than the wellness control, costs per minute of increase in PA were lower in the intervention. The print-based mail-delivered format has potential for broad, cost-effective dissemination, which could help address disparities in this at-risk population. TRIAL REGISTRATION: NCT01583140; Date of Registration: 03/06/2012; Funding Source of Trial: National Institute of Nursing Research (NINR); Name of Institutional Review Board: Brown University IRB; Date of Approval: 05/19/2009.","Int J Behav Nutr Phys Act 12(Number): 140","USA",2015,"Unspecified","Unspecified",null,"Unspecified","CEA","RCT","USA","Unspecified","Unspecified","Unspecified","CEA","RCT",null,"2015:2015"]
[47,"Larsen, B., et al. (2017). \"A Web-Based Physical Activity Intervention for Spanish-Speaking Latinas: A Costs and Cost-Effectiveness Analysis.\" J Med Internet Res 19(2): e43.",null,"Larsen, B., et al.","A Web-Based Physical Activity Intervention for Spanish-Speaking Latinas: A Costs and Cost-Effectiveness Analysis","BACKGROUND: Latinas report particularly low levels of physical activity and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that can increase physical activity in this growing population in a large-scale, cost-effective manner. Web-based interventions may have potential given the increase in Internet use among Latinas and the scalability of Web-based programs. OBJECTIVE: To examine the costs and cost-effectiveness of a Web-based, Spanish-language physical activity intervention for Latinas compared to a wellness contact control. METHODS: Healthy adult Latina women (N=205) were recruited from the community and randomly assigned to receive a Spanish-language, Web-based, individually tailored physical activity intervention (intervention group) or were given access to a website with content on wellness topics other than physical activity (control group). Physical activity was measured using the 7-Day Physical Activity Recall interview and ActiGraph accelerometers at baseline, 6 months (ie, postintervention), and 12 months (ie, maintenance phase). Costs were estimated from a payer perspective and included all features necessary to implement the intervention in a community setting, including staff time (ie, wages, benefits, and overhead), materials, hardware, website hosting, and routine website maintenance. RESULTS: At 6 months, the costs of running the intervention and control groups were US $17 and US $8 per person per month, respectively. These costs fell to US $12 and US $6 per person per month at 12 months, respectively. Linear interpolation showed that intervention participants increased their physical activity by 1362 total minutes at 6 months (523 minutes by accelerometer) compared to 715 minutes for control participants (186 minutes by accelerometer). At 6 months, each minute increase in physical activity for the intervention group cost US $0.08 (US $0.20 by accelerometer) compared to US $0.07 for control participants (US $0.26 by accelerometer). Incremental cost-per-minute increases associated with the intervention were US $0.08 at 6 months and US $0.04 at 12 months (US $0.16 and US $0.08 by accelerometer, respectively). Sensitivity analyses showed variations in staffing costs or intervention effectiveness yielded only modest changes in incremental costs. CONCLUSIONS: While the Web-based physical activity intervention was more expensive than the wellness control, both were quite low cost compared to face-to-face or mail-delivered interventions. Cost-effectiveness ranged markedly based on physical activity measure and was similar between the two conditions. Overall, the Web-based intervention was effective and low cost, suggesting a promising channel for increasing physical activity on a large scale in this at-risk population. CLINICALTRIAL: Clinicaltrials.gov NCT01834287; https://clinicaltrials.gov/ct2/show/NCT01834287 (Archived by WebCite at http://www.webcitation.org/6nyjX9Jrh).","J Med Internet Res 19(Number): e43","USA",2017,"Unspecified","Unspecified",null,"Adults","CEA","RCT","USA","Adults","Unspecified","Unspecified","CEA","RCT",null,"2017:2018"]
[48,"Larsen, K. T., et al. (2017). \"Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up.\" Scand J Public Health 45(6): 666-674.",null,"Larsen, K. T., et al.","Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up","AIMS: The aim was to analyse the cost-effectiveness of an intensive weight-loss intervention for children compared with a low-intensity intervention. METHODS: One hundred and fifteen overweight children (mean age 12.0 +/- 0.4) were randomised to either the camp group (CG) ( N=59) or the standard group (SG) ( N=56). Participants in the CG were offered a six-week day-camp weight-loss programme followed by a family-based supportive programme containing four meetings during the succeeding 46 weeks. Participants in the SG were offered a weekly two-hour exercise session for six weeks. Changes in body mass index (BMI) and BMI z-score 12 months after inclusion were used to compare the effects of the two interventions. Incremental cost-effectiveness ratios (ICER) were estimated from the perspective of a Danish municipality. To achieve the required number of participants, an additional intervention was initiated one year later. RESULTS: In comparison with the SG, the CG changed their mean BMI by -1.2 (95% CI -1.8 to -0.5). Compared with the SG children, the CG children changed their BMI z-score by -0.20 (95% CI -0.35 to -0.05). The ICER per decreased BMI point in the CG compared with the SG was DDK 24,928. CONCLUSIONS: Compared with the SG, the CG showed favourable effects after 12 months. However, the CG was more costly. The results observed in the present study may be helpful in guiding decision makers to take more informed decisions when choosing different types of intervention.","Scand J Public Health 45(Number): 666-674","Denmark",2017,"None","Day Camp",null,"Children","CEA","RCT","Denmark","Children","None","Day Camp","CEA","RCT",null,"2017:2018"]
[49,"Leininger, B., et al. (2016). \"Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain.\" Spine J 16(11): 1292-1304.",null,"Leininger, B., et al.","Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain","BACKGROUND CONTEXT: Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments. PURPOSE: This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA. STUDY DESIGN/SETTING: Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed. PATIENT SAMPLE: A total of 241 older adults (>/=65 years) with chronic mechanical neck pain comprised the patient sample. OUTCOME MEASURES: The outcome measures were direct and indirect costs, neck pain, neck disability, SF-6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1-year time horizon. METHODS: This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425). The RCT is registered at ClinicalTrials.gov (#NCT00269308). A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectivenesswas a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates. RESULTS: Total costs for SMT+HEA were 5% lower than HEA (mean difference: -$111; 95% confidence interval [CI] -$1,354 to $899) and 47% lower than SRE+HEA (mean difference: -$1,932; 95% CI -$2,796 to -$1,097). SMT+HEA also resulted in a greater reduction of neck pain over the year relative to HEA (0.57; 95% CI 0.23 to 0.92) and SRE+HEA (0.41; 95% CI 0.05 to 0.76). Differences in disability and QALYs favored SMT+HEA. The probability that adding SMT to HEA is cost-effective at willingness to pay thresholds of $50,000 to $200,000 per QALY gained ranges from 0.75 to 0.81. If adopting a health-care perspective, costs for SMT+HEA were 66% higher than HEA (mean difference: $515; 95% CI $225 to $1,094), resulting in an ICER of $55,975 per QALY gained. CONCLUSION: On average, SMT+HEA resulted in better clinical outcomes and lower total societal costs relative to SRE+HEA and HEA alone, with a 0.75 to 0.81 probability of cost-effectiveness for willingness to pay thresholds of $50,000 to $200,000 per QALY.","Spine J 16(Number): 1292-1304","USA",2016,"Musculoskeletal","Unspecified",null,"Adults","CUA","RCT","USA","Adults","Musculoskeletal","Unspecified","CUA","RCT",null,"2016:2016"]
[50,"Li, F. and P. Harmer (2015). \"Economic Evaluation of a Tai Ji Quan Intervention to Reduce Falls in People With Parkinson Disease, Oregon, 2008-2011.\" Prev Chronic Dis 12: E120.",null,"Li, F. and P. Harmer","Economic Evaluation of a Tai Ji Quan Intervention to Reduce Falls in People With Parkinson Disease, Oregon, 2008-2011","INTRODUCTION: Exercise is effective in reducing falls in people with Parkinson disease. However, information on the cost effectiveness of this approach is lacking. We conducted a cost-effectiveness analysis of Tai Ji Quan for reducing falls among patients with mild-to-moderate Parkinson disease. METHODS: We used data from a previous intervention trial to analyze resource use costs related to intervention delivery and number of falls observed during a 9-month study period. Cost effectiveness was estimated via incremental cost-effectiveness ratio (ICER) in which Tai Ji Quan was compared with 2 alternative interventions (Resistance training and Stretching) on the primary outcome of per fall prevented and the secondary outcome of per participant quality-adjusted life years (QALY) gained. We also conducted subgroup and sensitivity analyses. RESULTS: Tai Ji Quan was more effective than either Resistance training or Stretching; it had the lowest cost and was the most effective in improving primary and secondary outcomes. Compared with Stretching, Tai Ji Quan cost an average of $175 less for each additional fall prevented and produced a substantial improvement in QALY gained at a lower cost. Results from subgroup and sensitivity analyses showed no variation in cost-effectiveness estimates. However, sensitivity analyses demonstrated a much lower ICER ($27) when only intervention costs were considered. CONCLUSION: Tai Ji Quan represents a cost-effective strategy for optimizing spending to prevent falls and maximize health gains in people with Parkinson disease. While these results are promising, they warrant further validation.","Prev Chronic Dis 12(Number): E120","USA",2015,"Neuromuscular","Tai ji Quan",null,"Unspecified","CUA,CEA","RCT","USA","Unspecified","Neuromuscular","Tai ji Quan","CUA,CEA","RCT",null,"2015:2015"]
[51,"Li, F., et al. (2016). \"Implementing an Evidence-Based Fall Prevention Intervention in Community Senior Centers.\" Am J Public Health 106(11): 2026-2031.",null,"Li, F., et al.","Implementing an Evidence-Based Fall Prevention Intervention in Community Senior Centers","OBJECTIVES: To evaluate the impact of implementing an evidence-based fall prevention intervention in community senior centers. METHODS: We used a single-group design to evaluate the Tai Ji Quan: Moving for Better Balance (TJQMBB) program's adoption, population reach, implementation, effectiveness, and maintenance among 36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month postintervention follow-up. RESULTS: TJQMBB was adopted by 89% of the senior centers approached and reached 90% of the target population. The program resulted in a 49% reduction in the total number of falls and improved physical performance. Participation was well maintained after the program's completion. The average cost-effectiveness ratio for the 48-week program implementation was $917 per fall prevented and $676 per fall prevented for multiple falls. CONCLUSIONS: TJQMBB is an effective public health program that can be broadly implemented in community senior centers for primary prevention of falls among community-dwelling older adults.","Am J Public Health 106(Number): 2026-2031","USA",2016,"None","Home Based Training",null,"Adults","CEA","RCT","USA","Adults","None","Home Based Training","CEA","RCT",null,"2016:2016"]
[52,"Li, R., et al. (2015). \"Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force.\" Ann Intern Med 163(6): 452-460.",null,"Li, R., et al.","Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force","BACKGROUND: Diabetes is a highly prevalent and costly disease. Studies indicate that combined diet and physical activity promotion programs can prevent type 2 diabetes among persons at increased risk. PURPOSE: To systematically evaluate the evidence on cost, cost-effectiveness, and cost-benefit estimates of diet and physical activity promotion programs. DATA SOURCES: Cochrane Library, EMBASE, MEDLINE, PsycINFO, Sociological Abstracts, Web of Science, EconLit, and CINAHL through 7 April 2015. STUDY SELECTION: English-language studies from high-income countries that provided data on cost, cost-effectiveness, or cost-benefit ratios of diet and physical activity promotion programs with at least 2 sessions over at least 3 months delivered to persons at increased risk for type 2 diabetes. DATA EXTRACTION: Dual abstraction and assessment of relevant study details. DATA SYNTHESIS: Twenty-eight studies were included. Costs were expressed in 2013 U.S. dollars. The median program cost per participant was $653. Costs were lower for group-based programs (median, $417) and programs implemented in community or primary care settings (median, $424) than for the U.S. DPP (Diabetes Prevention Program) trial and the DPP Outcomes Study ($5881). Twenty-two studies assessed the incremental cost-effectiveness ratios (ICERs) of the programs. From a health system perspective, 16 studies reported a median ICER of $13 761 per quality-adjusted life-year (QALY) saved. Group-based programs were more cost-effective (median, $1819 per QALY) than those that used individual sessions (median, $15 846 per QALY). No cost-benefit studies were identified. LIMITATION: Information on recruitment costs and cost-effectiveness of translational programs implemented in community and primary care settings was limited. CONCLUSION: Diet and physical activity promotion programs to prevent type 2 diabetes are cost-effective among persons at increased risk. Costs are lower when programs are delivered to groups in community or primary care settings. PRIMARY FUNDING SOURCE: None.","Ann Intern Med 163(Number): 452-460","USA",2015,"None","Unspecified",null,"Unspecified","CUA","SLR","USA","Unspecified","None","Unspecified","CUA","SLR",null,"2015:2015"]
[53,"Little, P., et al. (2017). \"Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction).\" Health Technol Assess 21(4): 1-62.",null,"Little, P., et al.","Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)","BACKGROUND: Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed. OBJECTIVES: To estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice. DESIGN: Individually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews. SETTING: Primary care general practices in the UK. PARTICIPANTS: Patients with a body mass index of >/= 30 kg/m(2) (or >/= 28 kg/m(2) with risk factors) identified from general practice records, recruited by postal invitation. INTERVENTIONS: Positive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls). MAIN OUTCOME MEASURES: The primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months. RESULTS: A total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control, n = 227; POWeR+F, n = 221; POWeR+R, n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg; p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg; p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51; p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74; p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was pound18 (95% CI - pound129 to pound195) for POWeR+F and - pound25 (95% CI - pound268 to pound157) for POWeR+R. The probability of being cost-effective at a threshold of pound100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+. STUDY LIMITATIONS: Maintenance of weight loss after 1 year is unknown. FUTURE WORK: Identifying strategies for longer-term engagement, impact in community settings and increasing physical activity. CONCLUSION: Clinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective. TRIAL REGISTRATION: Current Controlled Trials ISRCTN21244703. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.","Health Technol Assess 21(Number): 1-62","UK",2017,"Various","Home Based Training",null,"Adults","CEA","RCT","UK","Adults","Various","Home Based Training","CEA","RCT",null,"2017:2018"]
[54,"Manning, V. L., et al. (2015). \"Economic evaluation of a brief education, self-management and upper limb exercise training in people with rheumatoid arthritis (EXTRA) programme: a trial-based analysis.\" Rheumatology (Oxford) 54(2): 302-309.",null,"Manning, V. L., et al.","Economic evaluation of a brief education, self-management and upper limb exercise training in people with rheumatoid arthritis (EXTRA) programme: a trial-based analysis","OBJECTIVE: The aim of this study was to conduct a cost-utility analysis of the Education, Self-management and Upper Limb Exercise Training in People with RA (EXTRA) programme compared with usual care. METHODS: A within-trial incremental cost-utility analysis was conducted with 108 participants randomized to either the EXTRA programme (n = 52) or usual care (n = 56). A health care perspective was assumed for the primary analysis with a 36 week follow-up. Resource use information was collected on interventions, medication, primary and secondary care contacts, private health care and social care costs. Quality-adjusted life years (QALYs) were calculated from the EuroQol five-dimension three-level (EQ-5D-3L) questionnaire responses at baseline, 12 and 36 weeks. RESULTS: Compared with usual care, total QALYs gained were higher in the EXTRA programme, leading to an increase of 0.0296 QALYs. The mean National Health Service (NHS) costs per participant were slightly higher in the EXTRA programme (by pound82), resulting in an incremental cost-effectiveness ratio of pound2770 per additional QALY gained. Thus the EXTRA programme was cost effective from an NHS perspective when assessed against the threshold of pound20 000- pound30 000/QALY gained. Overall, costs were lower in the EXTRA programme compared with usual care, suggesting it was the dominant treatment option from a societal perspective. At a willingness-to-pay of pound20 000/QALY gained, there was a 65% probability that the EXTRA programme was the most cost-effective option. These results were robust to sensitivity analyses accounting for missing data, changing the cost perspective and removing cost outliers. CONCLUSION: The physiotherapist-led EXTRA programme represents a cost-effective use of resources compared with usual care and leads to lower health care costs and work absence. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number Register; http://www.controlled-trials.com/isrctn/ (ISRCTN14268051).","Rheumatology (Oxford) 54(Number): 302-309","UK",2015,"Musculoskeletal","Unspecified",null,"Unspecified","CUA","RCT","UK","Unspecified","Musculoskeletal","Unspecified","CUA","RCT",null,"2015:2015"]
[55,"May, A. M., et al. (2017). \"Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study.\" BMJ Open 7(3): e012187.",null,"May, A. M., et al.","Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study","OBJECTIVE: Meta-analyses show that exercise interventions during cancer treatment reduce cancer-related fatigue. However, little is known about the cost-effectiveness of such interventions. Here we aim to assess the cost-effectiveness of the 18-week physical activity during cancer treatment (PACT) intervention for patients with breast and colon cancer. The PACT trial showed beneficial effects for fatigue and physical fitness. DESIGN: Cost-effectiveness analyses with a 9-month time horizon (18 weeks of intervention and 18 weeks of follow-up) within the randomised controlled multicentre PACT study. SETTING: Outpatient clinics of 7 hospitals in the Netherlands (1 academic and 6 general hospitals) PARTICIPANTS: 204 patients with breast cancer and 33 with colon cancer undergoing adjuvant treatment including chemotherapy. INTERVENTION: Supervised 1-hour aerobic and resistance exercise (twice per week for 18 weeks) or usual care. MAIN OUTCOME MEASURES: Costs, quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio. RESULTS: For colon cancer, the cost-effectiveness analysis showed beneficial effects of the exercise intervention with incremental costs savings of euro4321 and QALY improvements of 0.03. 100% of bootstrap simulations indicated that the intervention is dominant (ie, cheaper and more effective). For breast cancer, the results did not indicate that the exercise intervention was cost-effective. Incremental costs were euro2912, and the incremental effect was 0.01 QALY. At a Dutch threshold value of euro20 000 per QALY, the probability that the intervention is cost-effective was 2%. CONCLUSIONS: Our results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer. TRIAL REGISTRATION NUMBER: ISRCTN43801571.","BMJ Open 7(Number): e012187","Netherlands",2017,"Cancer,Cancer","Physiotherapy",null,"Unspecified","CUA","RCT","Netherlands","Unspecified","Cancer,Cancer","Physiotherapy","CUA","RCT",null,"2017:2018"]
[56,"McKinnon, R. A., et al. (2016). \"Obesity-Related Policy/Environmental Interventions: A Systematic Review of Economic Analyses.\" Am J Prev Med 50(4): 543-549.",null,"McKinnon, R. A., et al.","Obesity-Related Policy/Environmental Interventions: A Systematic Review of Economic Analyses","CONTEXT: Policy and environmental changes to support and encourage individual-level nutrition and physical activity behavior are underway in many parts of the U.S. and around the world at national, state, and local levels. Yet, to the authors' knowledge, no summary of the cost-benefit or cost-effectiveness studies of obesity-related policy/environmental interventions exists. EVIDENCE ACQUISITION: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines were followed to identify, screen, and describe the protocols used in this systematic review. In 2014, a unique search was conducted of titles and abstracts in MEDLINE, EconLit, SCOPUS, and Web of Science databases that were published from January 2002 through January 2014 in English-language, peer-reviewed journals. The search terms described obesity, physical activity, and diet in combination with economic evaluation. EVIDENCE SYNTHESIS: In 2014 and 2015, the results were analyzed. A total of 27 studies met the inclusion criteria, of which 26 described separate interventions. Of the 27 included studies, eight focused on the community and built environment, seven assessed nutrition-related changes, nine reported on the school environment, and three evaluated social marketing and media interventions. The vast majority of included studies reported beneficial economic outcomes of the interventions. CONCLUSIONS: Given the large and growing literature on the health and behavioral outcomes of policy and environmental interventions, the relatively low number of located cost-benefit and cost-effectiveness economic assessments appears to indicate a prime opportunity for the research community to address.","Am J Prev Med 50(Number): 543-549","International",2016,"Various","Unspecified",null,"Unspecified","CEA,CUA,CBA","SLR","International","Unspecified","Various","Unspecified","CEA,CUA,CBA","SLR",null,"2016:2016"]
[57,"McLean, K., et al. (2015). \"Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population.\" BMC Geriatr 15: 33.",null,"McLean, K., et al.","Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population","BACKGROUND: Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population. METHODS: A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP). RESULTS: The ICER of GBP pound51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP pound20,000 to pound30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP pound25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP pound99,664 per QALY and GBP pound50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP pound22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP pound48,212 in the women only base case analysis and GBP pound23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP pound652 (GBP pound616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even. CONCLUSIONS: The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.","BMC Geriatr 15(Number): 33","UK",2015,"None","Home Based Training",null,"Elderly","CUA","RCT","UK","Elderly","None","Home Based Training","CUA","RCT",null,"2015:2015"]
[58,"McRobbie, H., et al. (2016). \"Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme - a randomised controlled trial and economic evaluation.\" Health Technol Assess 20(79): 1-150.",null,"McRobbie, H., et al.","Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme - a randomised controlled trial and economic evaluation","BACKGROUND: An increasing number of people require help to manage their weight. The NHS recommends weight loss advice by general practitioners and/or a referral to a practice nurse. Although this is helpful for some, more effective approaches that can be disseminated economically on a large scale are needed. OBJECTIVE: To assess whether or not a task-based weight management programme [Weight Action Programme (WAP)] has better long-term effects than a 'best practice' intervention provided in primary care by practice nurses. DESIGN: Randomised controlled trial with cost-effectiveness analysis. SETTING: General practices in east London, UK. PARTICIPANTS: Three hundred and thirty adults with a body mass index (BMI) of >/= 30 kg/m(2) or a BMI of >/= 28 kg/m(2) plus comorbidities were recruited from local general practices and via media publicity. Those who had a BMI of > 45 kg/m(2), had lost > 5% of their body weight in the previous 6 months, were currently pregnant or taking psychiatric medications were excluded. Participants were randomised (2 : 1) to the WAP or nurse arms. INTERVENTIONS: The WAP intervention was delivered in eight weekly group sessions that combined dietary and physical activity, advice and self-monitoring in a group-oriented intervention. The initial course was followed by 10 monthly group maintenance sessions open to all participants in this study arm. The practice nurse intervention (best usual care) consisted of four one-to-one sessions delivered over 8 weeks, and included standard advice on diet and physical activity based on NHS 'Change4Life' materials and motivational support. MAIN OUTCOME MEASURES: The primary outcome measure was weight change at 12 months. Secondary outcome measures included change in BMI, waist circumference and blood pressure, and proportion of participants losing at least 5% and 10% of baseline body weight. Staff collecting measurements at the 6- and 12-month follow-ups were blinded to treatment allocation. The primary outcome measure was analysed according to the intention-to-treat principle, and included all participants with at least one recorded outcome at either 1, 2, 6 or 12 months. The analysis employed a mixed-effects linear regression model, adjusted for baseline weight, age, sex, ethnicity, smoking status and general practice. The European Quality of Life-5 Dimensions-5 Levels questionnaire was completed and used to estimate quality-adjusted life-years (QALYs) within the cost-effectiveness analysis. RESULTS: There were 330 participants (WAP arm, n = 221; nurse arm, n = 109; 72% women). A total of 291 (88%) participants (WAP arm, n = 194; nurse arm, n = 97) were included in the main analysis for the primary outcome. Weight loss at 12 months was greater in the WAP arm than in the nurse intervention arm [-4.2 kg vs. -2.3 kg; difference -1.9 kg, 95% confidence interval (CI) -3.7 to -0.1 kg; p = 0.04]. Participants in the WAP arm were more likely than participants in the nurse arm to have lost at least 5% of their baseline body weight at 12 months (41% vs. 27%; odds ratio 14.61, 95% CI 2.32 to 91.96; p = 0.004). The incremental cost-effectiveness ratio for WAP over and above the nurse arm is pound7742 per QALY. CONCLUSIONS: A WAP delivered in general practice better promotes weight loss over 12 months than a best usual practice nurse-led weight loss programme. LIMITATIONS: The trial recruited mostly women. Research is needed into factors that would make weight loss programmes more attractive to men. TRIAL REGISTRATION: Current Controlled Trials ISRCTN45820471. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 79. See the NIHR Journals Library website for further project information.","Health Technol Assess 20(Number): 1-150","UK",2016,"Various","Unspecified",null,"Any","CUA","RCT","UK","Any","Various","Unspecified","CUA","RCT",null,"2016:2016"]
[59,"Mewes, J. C., et al. (2017). \"Value of Implementation of Strategies to Increase the Adherence of Health Professionals and Cancer Survivors to Guideline-Based Physical Exercise.\" Value Health 20(10): 1336-1344.",null,"Mewes, J. C., et al.","Value of Implementation of Strategies to Increase the Adherence of Health Professionals and Cancer Survivors to Guideline-Based Physical Exercise","BACKGROUND: To increase the adherence of health professionals and cancer survivors to evidence-based physical exercise, effective implementation strategies (ISTs) are required. OBJECTIVES: To examine to what extent these ISTs provide value for money and which IST has the highest expected value. METHODS: The net benefit framework of health economic evaluations is used to conduct a value-of-implementation analysis of nine ISTs. Seven are directed to health professionals and two to cancer survivors. The analysis consists of four steps: 1) analyzing the expected value of perfect implementation (EVPIM); 2) assessing the estimated costs of the various ISTs; 3) comparing the ISTs' costs with the EVPIM; and 4) assessing the total net benefit (TNB) of the ISTs. These steps are followed to identify which strategy has the greatest value. RESULTS: The EVPIM for physical exercise in the Netherlands is euro293 million. The total costs for the ISTs range from euro34,000 for printed educational materials for professionals to euro120 million for financial incentives for patients, and thus all are cost-effective. The TNB of the ISTs that are directed to professionals ranges from euro5.7 million for printed educational materials to euro30.9 million for reminder systems. Of the strategies that are directed to patients, only the motivational program had a positive net benefit of euro100.4 million. CONCLUSIONS: All the ISTs for cancer survivors, except for financial incentives, had a positive TNB. The largest improvements in adherence were created by a motivational program for patients, followed by a reminder system for professionals.","Value Health 20(Number): 1336-1344","Netherlands",2017,"Cancer","Unspecified",null,"Unspecified","CBA","SLR","Netherlands","Unspecified","Cancer","Unspecified","CBA","SLR",null,"2017:2018"]
[60,"Milte, R., et al. (2016). \"Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture.\" J Rehabil Med 48(4): 378-385.",null,"Milte, R., et al.","Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture","OBJECTIVE: To undertake a cost-utility analysis of the Individual Nutrition Therapy and Exercise Regime: A Controlled Trial of Injured, Vulnerable Elderly (INTERACTIVE) trial. DESIGN: Cost-utility analysis of a randomized controlled trial. SUBJECTS: A total of 175 patients following a hip fracture were allocated to receive either alternate weekly visits from a physical therapist and dietitian (intervention group), or social visits for 6 months (control group). METHODS: Costs for utilization of hospitals, health and community services were compared with quality-adjusted life years gained, calculated from responses to the Assessment of Quality of Life instrument. RESULTS: There were minimal differences in mean costs between the intervention ($AUD 45,331 standard deviation (SD): $AUD 23,012) and the control group ($AUD 44,764 SD: $AUD 20,712, p = 0.868), but a slightly higher mean gain in quality-adjusted life years in the intervention group (0.155, SD: 0.132) compared with the control group (0.139, SD: 0.149, p = 0.470). The incremental cost-effectiveness ratio was $AUD 28,350 per quality-adjusted life year gained, which is below the implied cost-effectiveness threshold utilized by regulatory authorities in Australia. CONCLUSION: A comprehensive 6-month programme of therapy from dietitians and physical therapists could be provided at a relatively low additional cost in this group of frail older adults, and the incremental cost-effectiveness ratio indicates likely cost-effectiveness, although there was a very high level of uncertainty in the findings.","J Rehabil Med 48(Number): 378-385","Australia",2016,"Musculoskeletal","Physiotherapy",null,"Elderly","CUA","RCT","Australia","Elderly","Musculoskeletal","Physiotherapy","CUA","RCT",null,"2016:2016"]
[61,"Moore, J. B., et al. (2017). \"Cost-effectiveness of Community-Based Minigrants to Increase Physical Activity in Youth.\" J Public Health Manag Pract 23(4): 364-369.",null,"Moore, J. B., et al.","Cost-effectiveness of Community-Based Minigrants to Increase Physical Activity in Youth","CONTEXT: American youth are insufficiently active, and minigrant programs have been developed to facilitate implementation of evidence-based interventions in communities. However, little is known about the cost-effectiveness of targeted minigrant programs for the implementation of physical activity (PA) promoting strategies for youth. OBJECTIVE: To determine the cost-effectiveness of a minigrant program to increase PA among youth. DESIGN: Twenty community grantees were pair-matched and randomized to receive funding at the beginning of year 1 (2010-2011) or year 2 (2011-2012) to implement interventions to increase PA in youth. Costs were calculated by examining financial reports provided by the granting organization and grantees. SETTING: Twenty counties in North Carolina. PARTICIPANTS: A random sample of approximately 800 fourth- to eighth-grade youth (per year) from the approximately 6100 youth served by the 20 community-based interventions. MAIN OUTCOME MEASURE: Cost-effectiveness ratios (CERs) were calculated at the county and project levels to determine the cost per child-minute of moderate-to-vigorous PA (MVPA) increased by wave. Analyses were conducted utilizing cost data from 20 community grantees and accelerometer-derived PA from the participating youth. RESULTS: Of the 20 participating counties, 18 counties displayed increased youth MVPA between at least 2 waves of observation. Of those 18 counties, the CER (US dollars/MVPA minutes per day) ranged from $0.02 to $1.86 (n = 13) in intervention year 1, $0.02 to $6.19 (n = 15) in intervention year 2, and $0.02 to $0.58 (n = 17) across both years. CONCLUSION: If utilized to implement effectual behavior change strategies, minigrants can be a cost-effective means of increasing children's MVPA, with a low monetary cost per minute of MVPA.","J Public Health Manag Pract 23(Number): 364-369","USA",2017,"None","Unspecified",null,"Children,Adolescents","CEA","RCT","USA","Children,Adolescents","None","Unspecified","CEA","RCT",null,"2017:2018"]
[62,"Mori, T., et al. (2017). \"Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA.\" Osteoporos Int 28(2): 585-595.",null,"Mori, T., et al.","Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA","We developed a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women without prior major osteoporotic fractures over a lifetime horizon. At ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a conventionally accepted threshold compared with bisphosphonates alone. INTRODUCTION: The purpose of this study was to examine the cost-effectiveness of the combined strategy of oral bisphosphonate therapy for 5 years and falls prevention exercise for 1 year compared with either strategy in isolation. METHODS: We calculated incremental cost-effectiveness ratios [ICERs] (2014 US dollars per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women with different starting ages (65, 70, 75, and 80) without prior history of hip, vertebral, or wrist fractures over a lifetime horizon from the societal perspective. RESULTS: At ages 65, 70, 75, and 80, the combined strategy had ICERs of $202,020, $118,460, $46,870, and $17,640 per QALY, respectively, compared with oral bisphosphonate therapy alone. The combined strategy provided better health at lower cost than falls prevention exercise alone at ages 70, 75, and 80. In deterministic sensitivity analyses, results were particularly sensitive to the change in the opportunity cost of participants' time spent exercising. In probabilistic sensitivity analyses, the probabilities of the combined strategy being cost-effective compared with the next best alternative increased with age, ranging from 35 % at age 65 to 48 % at age 80 at a willingness-to-pay of $100,000 per QALY. CONCLUSIONS: Among community-dwelling US white women ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a willingness-to-pay of $100,000 per QALY, compared with oral bisphosphonate therapy only. This analysis will help clinicians and policymakers make better decisions about treatment options to reduce fracture risk.","Osteoporos Int 28(Number): 585-595","USA",2017,"Various","Home Based Training",null,"Elderly","CUA","Cohort","USA","Elderly","Various","Home Based Training","CUA","Cohort",null,"2017:2018"]
[63,"Mueller, N., et al. (2015). \"Health impact assessment of active transportation: A systematic review.\" Prev Med 76: 103-114.",null,"Mueller, N., et al.","Health impact assessment of active transportation: A systematic review","OBJECTIVE: Walking and cycling for transportation (i.e. active transportation, AT), provide substantial health benefits from increased physical activity (PA). However, risks of injury from exposure to motorized traffic and their emissions (i.e. air pollution) exist. The objective was to systematically review studies conducting health impact assessment (HIA) of a mode shift to AT on grounds of associated health benefits and risks. METHODS: Systematic database searches of MEDLINE, Web of Science and Transportation Research International Documentation were performed by two independent researchers, augmented by bibliographic review, internet searches and expert consultation to identify peer-reviewed studies from inception to December 2014. RESULTS: Thirty studies were included, originating predominantly from Europe, but also the United States, Australia and New Zealand. They compromised of mostly HIA approaches of comparative risk assessment and cost-benefit analysis. Estimated health benefit-risk or benefit-cost ratios of a mode shift to AT ranged between -2 and 360 (median=9). Effects of increased PA contributed the most to estimated health benefits, which strongly outweighed detrimental effects of traffic incidents and air pollution exposure on health. CONCLUSION: Despite different HIA methodologies being applied with distinctive assumptions on key parameters, AT can provide substantial net health benefits, irrespective of geographical context.","Prev Med 76(Number): 103-114","International",2015,"None","Walking,Cycling",null,"Any","CBA","SLR","International","Any","None","Walking,Cycling","CBA","SLR",null,"2015:2015"]
[64,"Neumann, A., et al. (2017). \"The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program.\" Eur J Health Econ 18(7): 905-919.",null,"Neumann, A., et al.","The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program","BACKGROUND: Policymakers need to know the cost-effectiveness of interventions to prevent type 2 diabetes (T2D). The objective of this study was to estimate the cost-effectiveness of a T2D prevention initiative targeting weight reduction, increased physical activity and healthier diet in persons in pre-diabetic states by comparing a hypothetical intervention versus no intervention in a Swedish setting. METHODS: A Markov model was used to study the cost-effectiveness of a T2D prevention program based on lifestyle change versus a control group where no prevention was applied. Analyses were done deterministically and probabilistically based on Monte Carlo simulation for six different scenarios defined by sex and age groups (30, 50, 70 years). Cost and quality adjusted life year (QALY) differences between no intervention and intervention and incremental cost-effectiveness ratios (ICERs) were estimated and visualized in cost-effectiveness planes (CE planes) and cost-effectiveness acceptability curves (CEA curves). RESULTS: All ICERs were cost-effective and ranged from 3833 euro/QALY gained (women, 30 years) to 9215 euro/QALY gained (men, 70 years). The CEA curves showed that the probability of the intervention being cost-effective at the threshold value of 50,000 euro per QALY gained was very high for all scenarios ranging from 85.0 to 91.1%. DISCUSSION/CONCLUSION: The prevention or the delay of the onset of T2D is feasible and cost-effective. A small investment in healthy lifestyle with change in physical activity and diet together with weight loss are very likely to be cost-effective.","Eur J Health Econ 18(Number): 905-919","Sweden",2017,"None","Unspecified",null,"Adults,Elderly","CUA","RCT","Sweden","Adults,Elderly","None","Unspecified","CUA","RCT",null,"2017:2018"]
[65,"Neumann, P. J., et al. (2016). \"Lack of Cost-Effectiveness Analyses to Address Healthy People 2020 Priority Areas.\" Am J Public Health 106(12): 2205-2207.",null,"Neumann, P. J., et al.","Lack of Cost-Effectiveness Analyses to Address Healthy People 2020 Priority Areas","OBJECTIVES: To examine the extent to which recently published cost-utility analyses (cost-effectiveness analyses using quality-adjusted life-years to measure health benefits) have covered the leading health concerns in the US Department of Health and Human Services Healthy People 2020 report. METHODS: We examined data in the Tufts Medical Center Cost-Effectiveness Analysis Registry, a database containing 5000 published cost-utility analyses published in the MEDLINE literature through 2014. We focused on US-based cost-utility analyses published from 2011 through 2014 (n = 687). Two reviewers scanned abstracts and met for a consensus on categorization of cost-utility analyses that addressed the specific priorities listed in the 12 Healthy People 2020 areas (n = 120). RESULTS: Although 7.3% of recently published cost-utility analyses addressed key clinical preventive services, only about 2% of recently published cost-utility analyses covered each of the following Healthy People 2020 topics: reproductive and sexual health, nutrition/physical activity/obesity, maternal and infant health, and tobacco. Fewer than 1% addressed priorities such as injuries and violence, mental health or substance abuse, environmental quality, and oral health. CONCLUSIONS: Few cost-utility analyses have addressed Healthy People 2020 priority areas.","Am J Public Health 106(Number): 2205-2207","International",2016,"None","Unspecified",null,"Unspecified","CUA","SLR","International","Unspecified","None","Unspecified","CUA","SLR",null,"2016:2016"]
[66,"Oppong, R., et al. (2015). \"Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials.\" Rheumatology (Oxford) 54(5): 876-883.",null,"Oppong, R., et al.","Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials","OBJECTIVES: Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand OA is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytical methodologies. METHODS: A trial-based economic evaluation to assess the cost-utility of joint protection only, hand exercises only and joint protection plus hand exercises compared with leaflet and advice was undertaken over a 12 month period from a UK National Health Service perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves were constructed. The base case analysis used a within-the-table analysis methodology. Two further methods were explored: the at-the-margins approach and a regression-based approach with or without an interaction term. RESULTS: Mean costs (QALYs) were pound58.46 (s.d. 0.662) for leaflet and advice, pound92.12 (s.d. 0.659) for joint protection, pound64.51 (s.d. 0.681) for hand exercises and pound112.38 (s.d. 0.658) for joint protection plus hand exercises. In the base case, hand exercises were the cost-effective option, with an ICER of pound318 per QALY gained. Hand exercises remained the most cost-effective management strategy when adopting alternative methodological approaches. CONCLUSION: This is the first trial evaluating the cost-effectiveness of occupational therapy-supported approaches to self-management for hand OA. Our findings showed that hand exercises were the most cost-effective option.","Rheumatology (Oxford) 54(Number): 876-883","UK",2015,"Musculoskeletal","Unspecified",null,"Unspecified","CUA","RCT","UK","Unspecified","Musculoskeletal","Unspecified","CUA","RCT",null,"2015:2015"]
[67,"Panman, C. M., et al. (2016). \"Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care.\" Menopause 23(12): 1307-1318.",null,"Panman, C. M., et al.","Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care","OBJECTIVE: We investigated the effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training (PFMT) in women with pelvic organ prolapse over a 2-year period. METHODS: Randomized controlled trial with women (>/=55 y) with symptomatic pelvic organ prolapse, identified by screening. Participants were recruited from 20 primary care practices (October 2009-December 2012). Primary outcome was the difference in change of pelvic floor symptoms (PFDI-20 score) between groups over 24 months. Secondary outcomes included prolapse, urinary, and anorectal symptoms; quality of life; costs; sexual functioning; prolapse stage; pelvic floor muscle function; and participants' perceived symptom improvement. RESULTS: There was a nonsignificant difference in the primary outcome between pessary treatment (n = 82) and PFMT (n = 80) with a mean difference of -3.7 points (95% CI, -12.8 to 5.3; P = 0.42) in favor of pessary treatment. A significantly greater improvement in the prolapse symptom score was, however, seen with pessary treatment (mean difference -3.2 points [95% CI, -6.3 to -0.0; P = 0.05]). Direct medical costs over the 2-year study were $309 and $437 per person for pessary treatment and PFMT, respectively. CONCLUSIONS: In older women with symptomatic prolapse, there was no significant difference between pessary treatment and PFMT in reducing pelvic floor symptoms, but specific prolapse-related symptoms did improve more with pessary treatment. Pessary treatment was preferable in the cost-effectiveness analysis. When counseling women for prolapse treatment it should, however, be taken into account that pessary fitting fails in a considerable portion of women and that pessary treatment was associated with more side effects compared with PFMT.","Menopause 23(Number): 1307-1318","Unclear",2016,"Various","Home Based Training",null,"Unspecified","CEA","RCT","Unclear","Unspecified","Various","Home Based Training","CEA","RCT",null,"2016:2016"]
[68,"Patil, R., et al. (2016). \"Cost-effectiveness of vitamin D supplementation and exercise in preventing injurious falls among older home-dwelling women: findings from an RCT.\" Osteoporos Int 27(1): 193-201.",null,"Patil, R., et al.","Cost-effectiveness of vitamin D supplementation and exercise in preventing injurious falls among older home-dwelling women: findings from an RCT","UNLABELLED: This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older home-dwelling Finnish women. Given a willingness to pay of euro3,000 per injurious fall prevented, the exercise intervention had an 86 % probability of being cost-effective in this population. INTRODUCTION: The costs of falling in older persons are high, both to the individual and to society. Both vitamin D and exercise have been suggested to reduce the risk of falls. This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older Finnish women. METHODS: Economic evaluation was based on the results of a previously published 2-year randomized controlled trial (RCT) where 409 community-dwelling women aged 70 to 80 years were recruited into four groups: (1) no exercise + placebo (D-Ex-), (2) no exercise + vitamin D 800 IU/day (D+Ex-), (3) exercise + placebo (D-Ex+), and (4) exercise + vitamin D 800 IU/day (D+Ex+). The outcomes were medically attended injurious falls and fall-related health care utilization costs over the intervention period, the latter evaluated from a societal perspective based on 2011 unit costs. Incremental cost-effectiveness ratios (ICER) were calculated for the number of injurious falls per person-year prevented and uncertainty estimated using bootstrapping. RESULTS: Incidence rate ratios (95 % CI) for medically attended injurious falls were lower in both Ex+ groups compared with D-Ex-: 0.46 (0.22 to 0.95) for D-Ex+, 0.38 (0.17 to 0.81) for D+Ex+. Step-wise calculation of ICERs resulted in exclusion of D+Ex- as more expensive and less effective. Recalculated ICERs were euro221 for D-Ex-, euro708 for D-Ex+, and euro3,820 for D+Ex+; bootstrapping indicated 93 % probability that each injurious fall avoided by D-Ex+ per person year costs euro708. At a willingness to pay euro3,000 per injurious fall prevented, there was an 85.6 % chance of the exercise intervention being cost-effective in this population. CONCLUSIONS: Exercise was effective in reducing fall-related injuries among community-dwelling older women at a moderate cost. Vitamin D supplementation had marginal additional benefit. The results provide a firm basis for initiating feasible and cost-effective exercise interventions in this population.","Osteoporos Int 27(Number): 193-201","Finland",2016,"Various","Home Based Training",null,"Elderly","CEA","RCT","Finland","Elderly","Various","Home Based Training","CEA","RCT",null,"2016:2016"]
[69,"Priebe, S., et al. (2016). \"Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial.\" Health Technol Assess 20(11): vii-xxiii, 1-100.",null,"Priebe, S., et al.","Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial","BACKGROUND: The negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control. DESIGN: A parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted. PARTICIPANTS: ELIGIBILITY CRITERIA: age 18-65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of >/= 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient. EXCLUSION CRITERIA: inability to participate in the groups and insufficient command of English. SETTINGS: Participants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces. INTERVENTIONS: Control intervention: a 10-week, 90-minute, 20-session group beginners' Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist. OUTCOMES: The primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up. RESULTS: A total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in means of the PANSS negative subscale at the end of treatment was 0.03 [95% confidence interval (CI) -1.11 to 1.17], showing no advantage of the intervention. In the secondary outcomes, the mean difference in the Clinical Assessment Interview for negative symptoms expression subscale at the end of treatment was 0.62 (95% CI -1.23 to 0.00), and in extrapyramidal movement disorder symptoms -0.65 (95% CI -1.13 to -0.16) at the end of treatment and -0.58 (95% CI -1.07 to -0.09) at 6 months' follow-up, showing a small significant advantage of body psychotherapy. No serious adverse events related to the interventions were reported. The total costs of the intervention were comparable with the control, with no clear evidence of cost-effectiveness for either condition. LIMITATIONS: Owing to the absence of a treatment-as-usual arm, it is difficult to determine whether or not both arms are an improvement over routine care. CONCLUSIONS: In comparison with an active control, group body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia. These findings conflict with the review that led to the current National Institute for Health and Care Excellence guidelines suggesting that arts therapies may be an effective treatment for negative symptoms. FUTURE WORK: Determining whether or not this lack of effectiveness extends to all types of art therapies would be informative. TRIAL REGISTRATION: Current Controlled Trials ISRCTN842165587. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 11. See the NIHR Journals Library website for further project information.","Health Technol Assess 20(Number): vii-xxiii, 1-100","UK",2016,"Mental Illness","Dance",null,"Adults","CEA","RCT","UK","Adults","Mental Illness","Dance","CEA","RCT",null,"2016:2016"]
[70,"Rincon, M., et al. (2016). \"Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia.\" J Cardiopulm Rehabil Prev 36(1): 12-19.",null,"Rincon, M., et al.","Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia","PURPOSE: Cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) has met with resistance from third-party payers in low- and middle-income countries because of lack of evidence regarding its cost-effectiveness. We aimed to provide information to help better inform this decision-making process. METHODS: Costs associated with a 12-week exercise-based rehabilitation program in Colombia for patients with CHF were estimated. We collected data on all medical resources used in ambulatory care and data on hospital costs incurred for treating patients with uncompensated CHF. A literature search to establish the hospitalization rates because of uncompensated CHF, death because of CHF, and potential decreases in these data because of the utilization of CR was conducted. We modeled incremental costs and effectiveness over a period of 5 years from the perspective of the third-party payer. RESULTS: All costs were converted from Colombian pesos to US dollars. For an exercise-based CR program of 12-week duration (36 sessions), costs ranged from US$265 to US$369 per patient. Monthly costs associated with ambulatory care of CHF averaged US$128 +/- US$321 per patient, and hospitalization costs were US$3621 +/- US$5 444 per event. Yearly hospitalization incidence rates with and without CR were 0.154 and 0.216, respectively. The incremental cost of CR would be US$998 per additional quality-adjusted life-year. Sensitivity analysis did not significantly change these results. CONCLUSIONS: Cardiac rehabilitation in patients with CHF in settings such as Colombia can be a cost-effective strategy, with minimal incremental costs and better quality of life, mainly because of decreased rates of hospitalization.","J Cardiopulm Rehabil Prev 36(Number): 12-19","Colombia",2016,"Cardiovascular","Unspecified",null,"Unspecified","CUA","Cohort","Colombia","Unspecified","Cardiovascular","Unspecified","CUA","Cohort",null,"2016:2016"]
[71,"Robertson, W., et al. (2017). \"Randomised controlled trial and economic evaluation of the 'Families for Health' programme to reduce obesity in children.\" Arch Dis Child 102(5): 416-426.",null,"Robertson, W., et al.","Randomised controlled trial and economic evaluation of the 'Families for Health' programme to reduce obesity in children","OBJECTIVE: Evaluating effectiveness and cost-effectiveness of 'Families for Health V2' (FFH) compared with usual care (UC). DESIGN: Multicentre randomised controlled trial (RCT) (investigators blinded, families unblinded) and economic evaluation. Stratified randomisation by family; target of 120 families. SETTING: Three National Health Service Primary Care Trusts in West Midlands, England. PARTICIPANTS: Overweight or obese (>/=91st or >/=98th centile body mass index (BMI)) children aged 6-11 years and their parents/carers, recruited March 2012-February 2014. INTERVENTIONS: FFH; a 10-week community-based family programme addressing parenting, lifestyle change and social and emotional development. UC; usual support for childhood obesity at each site. MAIN OUTCOME MEASURES: Primary outcomes were 12-months change in children's BMI z-score and incremental cost per quality-adjusted life-year gained (QALY). Secondary outcomes included changes in children's physical activity, fruit and vegetable consumption and quality of life, parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style. RESULTS: 115 families (128 children) were randomised to FFH (n=56) or UC (n=59). There was no significant difference in BMI z-score 12-months change (0.114, 95% CI -0.001 to 0.229, p=0.053; p=0.026 in favour of UC with missing value multiple imputation). One secondary outcome, change in children's waist z-score, was significantly different between groups in favour of UC (0.15, 95% CI 0.00 to 0.29). Economic evaluation showed that mean costs were significantly higher for FFH than UC ( pound998 vs pound548, p<0.001). Mean incremental cost-effectiveness of FFH was estimated at pound552 175 per QALY. CONCLUSIONS: FFH was neither effective nor cost-effective for the management of obesity compared with UC. TRIAL REGISTRATION NUMBER: ISRCTN45032201.","Arch Dis Child 102(Number): 416-426","UK",2017,"Various","Unspecified",null,"Children","CUA","RCT","UK","Children","Various","Unspecified","CUA","RCT",null,"2017:2018"]
[72,"Robertson, W., et al. (2017). \"Randomised controlled trial evaluating the effectiveness and cost-effectiveness of 'Families for Health', a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years.\" Health Technol Assess 21(1): 1-180.",null,"Robertson, W., et al.","Randomised controlled trial evaluating the effectiveness and cost-effectiveness of 'Families for Health', a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years","BACKGROUND: Effective programmes to help children manage their weight are required. 'Families for Health' focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health version 1 showed sustained reductions in mean body mass index (BMI) z-score after 2 years in a pilot project. OBJECTIVE: The aim was to evaluate its effectiveness and cost-effectiveness in a randomised controlled trial (RCT). DESIGN: The trial was a multicentre, investigator-blind RCT, with a parallel economic and process evaluation, with follow-up at 3 and 12 months. Randomisation was by family unit, using a 1 : 1 allocation by telephone registration, stratified by three sites, with a target of 120 families. SETTING: Three sites in the West Midlands, England, UK. PARTICIPANTS: Children aged 6-11 years who were overweight (>/= 91st centile BMI) or obese (>/= 98th centile BMI), and their parents/carers. Recruitment was via referral or self-referral. INTERVENTIONS: Families for Health version 2 is a 10-week, family-based community programme with parallel groups for parents and children, addressing parenting, lifestyle, social and emotional development. Usual care was the treatment for childhood obesity provided within each locality. MAIN OUTCOME MEASURES: Joint primary outcome measures were change in children's BMI z-score and incremental cost per quality-adjusted life-year (QALY) gained at 12 months' follow-up (QALYs were calculated using the European Quality of Life-5 Dimensions Youth version). Secondary outcome measures included changes in children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. Parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style were also assessed. The process evaluation documented recruitment, reach, dose delivered, dose received and fidelity, using mixed methods. RESULTS: The study recruited 115 families (128 children; 63 boys and 65 girls), with 56 families randomised to the Families for Health arm and 59 to the 'usual-care' control arm. There was 80% retention of families at 3 months (Families for Health, 46 families; usual care, 46 families) and 72% retention at 12 months (Families for Health, 44 families; usual care, 39 families). The change in BMI z-score at 12 months was not significantly different in the Families for Health arm and the usual-care arm [0.114, 95% confidence interval (CI) -0.001 to 0.229; p = 0.053]. However, within-group analysis showed that the BMI z-score was significantly reduced in the usual-care arm (-0.118, 95% CI -0.203 to -0.034; p = 0.007), but not in the Families for Health arm (-0.005, 95% CI -0.085 to 0.078; p = 0.907). There was only one significant difference between groups for secondary outcomes. The economic evaluation, taking a NHS and Personal Social Services perspective, showed that mean costs 12 months post randomisation were significantly higher for Families for Health than for usual care ( pound998 vs. pound548; p < 0.001). The mean incremental cost-effectiveness of Families for Health was estimated at pound552,175 per QALY gained. The probability that the Families for Health programme is cost-effective did not exceed 40% across a range of thresholds. The process evaluation demonstrated that the programme was implemented, as planned, to the intended population and any adjustments did not deviate widely from the handbook. Many families waited more than 3 months to receive the intervention. Facilitators', parents' and children's experiences of Families for Health were largely positive and there were no adverse events. Further analysis could explore why some children show a clinically significant benefit while others have a worse outcome. CONCLUSIONS: Families for Health was neither effective nor cost-effective for the management of obesity in children aged 6-11 years, in comparison with usual care. Further exploration of the wide range of responses in BMI z-score in children following the Families for Health and usual-care interventions is warranted, focusing on children who had a clinically significant benefit and those who showed a worse outcome with treatment. Further research could focus on the role of parents in the prevention of obesity, rather than treatment. TRIAL REGISTRATION: Current Controlled Trials ISRCTN45032201. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 1. See the NIHR Journals Library website for further project information.","Health Technol Assess 21(Number): 1-180","UK",2017,"Various","Unspecified",null,"Children","CUA","RCT","UK","Children","Various","Unspecified","CUA","RCT",null,"2017:2018"]
[73,"Roux, L., et al. (2015). \"Does age modify the cost-effectiveness of community-based physical activity interventions?\" J Phys Act Health 12(2): 224-231.",null,"Roux, L., et al.","Does age modify the cost-effectiveness of community-based physical activity interventions?","BACKGROUND: Community-based efforts to promote physical activity (PA) in adults have been found to be cost-effective in general, but it is unknown if this is true in middle-age specifically. Age group-specific economic evaluations could help inform the design and delivery of better and more tailored PA promotion. METHODS: A Markov model was developed to estimate the cost-effectiveness (CE) of 7 exemplar community-level interventions to promote PA recommended by the Guide to Community Preventive Services, over a 20-year horizon. The CE of these interventions in 25- to 64-year-old adults was compared with their CE in middle-aged adults, aged 50 to 64 years. The robustness of the results was examined through sensitivity analyses. RESULTS: Cost/QALY (quality-adjusted life year) of the evaluated interventions in 25- to 64-year-olds ranged from $42,456/QALY to $145,868/QALY. Interventions were more cost-effective in middle-aged adults, with CE ratios 38% to 47% lower than in 25- to 64-year-old adults. Sensitivity analyses showed greater than a 90% probability that the true CE of 4 of the 7 interventions was below $125,000/QALY in adults aged 50 to 64 years. CONCLUSION: The exemplar PA promotion interventions evaluated appeared to be especially cost-effective for middle-aged adults. Prioritizing such efforts to this age group is a good use of societal resources.","J Phys Act Health 12(Number): 224-231","Unclear",2015,"Various","Unspecified",null,"Adults","CUA","Cohort","Unclear","Adults","Various","Unspecified","CUA","Cohort",null,"2015:2015"]
[74,"Rush, E., et al. (2016). \"Project Energize: intervention development and 10 years of progress in preventing childhood obesity.\" BMC Res Notes 9: 44.",null,"Rush, E., et al.","Project Energize: intervention development and 10 years of progress in preventing childhood obesity","Prevention of childhood obesity is a global priority. The school setting offers access to large numbers of children and the ability to provide supportive environments for quality physical activity and nutrition. This article describes Project Energize, a through-school physical activity and nutrition programme that celebrated its 10-year anniversary in 2015 so that it might serve as a model for similar practices, initiatives and policies elsewhere. The programme was envisaged and financed by the Waikato District Health Board of New Zealand in 2004 and delivered by Sport Waikato to 124 primary schools as a randomised controlled trial from 2005 to 2006. The programme has since expanded to include all 242 primary schools in the Waikato region and 70 schools in other regions, including 53,000 children. Ongoing evaluation and development of Project Energize has shown it to be sustainable (ongoing for >10 years), both effective (lower obesity, higher physical fitness) and cost effective (one health related cost quality adjusted life year between $18,000 and $30,000) and efficient ($45/child/year) as a childhood 'health' programme. The programme's unique community-based approach is inclusive of all children, serving a population that is 42% Maori, the indigenous people of New Zealand. While the original nine healthy eating and seven quality physical activity goals have not changed, the delivery and assessment processes has been refined and the health service adapted over the 10 years of the programme existence, as well as adapted over time to other settings including early childhood education and schools in Cork in Ireland. Evaluation and research associated with the programme delivery and outcomes are ongoing. The dissemination of findings to politicians and collaboration with other service providers are both regarded as priorities.","BMC Res Notes 9(Number): 44","New Zealand",2016,"Various","Unspecified",null,"Children","CUA","Narrative review","New Zealand","Children","Various","Unspecified","CUA","Narrative review",null,"2016:2016"]
[75,"Sangster, J., et al. (2015). \"A comparison of the cost-effectiveness of two pedometer-based telephone coaching programs for people with cardiac disease.\" Heart Lung Circ 24(5): 471-479.",null,"Sangster, J., et al.","A comparison of the cost-effectiveness of two pedometer-based telephone coaching programs for people with cardiac disease","INTRODUCTION: Following a cardiac event it is recommended that cardiac patients participate in cardiac rehabilitation (CR) programs. However, little is known about the relative cost-effectiveness of lifestyle-related interventions for cardiac patients. This study aimed to compare the cost-effectiveness of a telephone-delivered Healthy Weight intervention to a telephone-delivered Physical Activity intervention for patients referred to CR in urban and rural Australia. METHODS: A cost-utility analysis was conducted alongside a randomised controlled trial of the two interventions. Outcomes were measured as Quality Adjusted Life Years (QALYs) gained. RESULTS: The estimated cost of delivering the interventions was $201.48 per Healthy Weight participant and $138.00 per Physical Activity participant. The average total cost (cost of health care utilisation plus patient costs) was $1,260 per Healthy Weight participant and $2,112 per Physical Activity participant, a difference of $852 in favour of the Healthy Weight intervention. Healthy Weight participants gained an average of 0.007 additional QALYs than did Physical Activity participants. Thus, overall the Healthy Weight intervention dominated the Physical Activity intervention (Healthy Weight intervention was less costly and more effective than the Physical Activity intervention). Subgroup analyses showed the Healthy Weight intervention also dominated the Physical Activity intervention for rural participants and for participants who did not attend CR. CONCLUSIONS: The low-contact pedometer-based telephone coaching Healthy Weight intervention is overall both less costly and more effective compared to the Physical Activity intervention, including for rural cardiac patients and patients that do not attend CR.","Heart Lung Circ 24(Number): 471-479","Australia",2015,"Cardiovascular","Unspecified",null,"Unspecified","CUA","RCT","Australia","Unspecified","Cardiovascular","Unspecified","CUA","RCT",null,"2015:2015"]
[76,"Schasfoort, F., et al. (2018). \"Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study.\" J Rehabil Med 50(1): 22-29.",null,"Schasfoort, F., et al.","Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study","OBJECTIVE: Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. DESIGN: A pragmatically designed, multi-centre trial, comparing the effectiveness of botulinum toxin + intensive physiotherapy with intensive physiotherapy alone, including economic evaluation. SUBJECTS/PATIENTS: Children with spastic cerebral palsy, age range 4-12 years, cerebral palsy-severity Gross Motor Function Classification System levels I-III, received either botulinum toxin type A + intensive physiotherapy or intensive physiotherapy alone and, if necessary, ankle-foot orthoses and/or casting. METHODS: Primary outcomes were gross motor func-tion, physical activity levels, and health-related quality-of-life, assessed at baseline, 12 (primary end-point) and 24 weeks (follow-up). Economic outcomes included healthcare and patient costs. Intention-to-treat analyses were performed with linear mixed models. RESULTS: There were 65 participants (37 males), with a mean age of 7.3 years (standard deviation 2.3 years), equally distributed across Gross Motor Function Classification System levels. Forty-one children received botulinum toxin type A plus intensive physio-therapy and 24 received intensive physiotherapy treatment only. At primary end-point, one statistically significant difference was found in favour of intensive physiotherapy alone: objectively measured percentage of sedentary behaviour (-3.42, 95% confidence interval 0.20-6.64, p=0.038). Treatment costs were significantly higher for botulinum toxin type A plus intensive physiotherapy (8,963 vs 6,182 euro, p=0.001). No statistically significant differences were found between groups at follow-up. CONCLUSION: The addition of botulinum toxin type A to intensive physiotherapy did not improve the effectiveness of rehabilitation for ambulatory children with spastic cerebral palsy and was also not cost-effective. Thus botulinum toxin is not recommended for use in improving gross motor function, activity levels or health-related quality-of-life in this cerebral palsy age- and severity-subgroup.","J Rehabil Med 50(Number): 22-29","Unclear",2018,"Neuromuscular","Unspecified",null,"Children","CUA","RCT","Unclear","Children","Neuromuscular","Unspecified","CUA","RCT",null,"2017:2018"]
[77,"Shephard, R. J. (2016). \"Sickle cell trait: what are the costs and benefits of screening?\" J Sports Med Phys Fitness 56(12): 1562-1573.",null,"Shephard, R. J.","Sickle cell trait: what are the costs and benefits of screening?","INTRODUCTION: Eight percent of African Americans are carriers of the sickle cell trait. Some regard this as a benign anomaly, but others point to incidents of sudden exercise-related death, calling for a preliminary screening of either all athletes or those of African-American ancestry. This brief review considers the costs and benefits of such screening. EVIDENCE ACQUISITION: The Ovid/Health Star data-base was searched from 1996 to June 2015. 2014. The terms \"exercise\", \"exercise therapy\", \"sports\", \"athletes\", \"physical activity/motor activity\" and \"physical fitness\" were combined to yield 227,120 citations. Likewise, the terms \"sickle cell trait\", \"sickle cell disease\", \"splenic infarction\", \"hemoglobin S\" and \"rhabdomyolysis\" identified 12,325 citations. A combination of the 2 searches yielded 416 abstracts. EVIDENCE SYNTHESIS: Excluding items relating to animal research or forms of rhabdomyolysis other than sickling left 375 abstracts; 115 papers merited full examination. This material covered the risks of sickle cell trait and of screening (55 items), effects upon physical performance (31 items), cellular mechanisms (23 items), nutrition (4 items), and other topics (2 items). Supplemented material was drawn from reference lists and personal files. The tendency to sickling was provoked by excessive exercise relative to physical condition in hot or hypoxic conditions, and by local tissue acidosis, conditions that were best avoided by all athletes. The condition had little impact upon physical performance, but the relative risks of heat illness, exertional rhabdomyolysis, splenic infarction and sudden death were all increased by the sickle cell trait. The absolute number of critical incidents was nevertheless small, calling for close assessment of the costs and putative benefits of widespread screening. CONCLUSIONS: Sports physicians should be aware of the clinical picture of sickling and be prepared to treat it. Screening may be cost-effective if targeted to black athletes involved in certain sports, although it has yet to be demonstrated how far the diagnosis of sickle cell trait reduces the risk of death when exercising in an adverse environment. A better tactic may be to reduce risks for all competitors by educating athletes and their coaches to adopt an intensity of training appropriate to the individual's physical condition, to maintain full hydration, and to avoid exposure to excessive heat and hypoxia.","J Sports Med Phys Fitness 56(Number): 1562-1573","International",2016,"Various","Multiple",null,"Unspecified","CBA","SLR","International","Unspecified","Various","Multiple","CBA","SLR",null,"2016:2016"]
[78,"Simpson, S. A., et al. (2015). \"A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults.\" Health Technol Assess 19(50): v-vi, xix-xxv, 1-378.",null,"Simpson, S. A., et al.","A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults","BACKGROUND: Obesity has significant health and NHS cost implications. Relatively small reductions in weight have clinically important benefits, but long-term weight loss maintenance (WLM) is challenging. Behaviour change interventions have been identified as key for WLM. Motivation is crucial to supporting behaviour change, and motivational interviewing (MI) has been identified as a successful approach to changing health behaviours. The study was designed as an adequately powered, pragmatic randomised controlled trial (RCT); however, owing to recruitment issues, the study became a feasibility trial. OBJECTIVES: To assess recruitment, retention, feasibility, acceptability, compliance and delivery of a 12-month intervention to support WLM. Secondary objectives were to assess the impact of the intervention on body mass index (BMI) and other secondary outcomes. DESIGN: Three-arm individually randomised controlled trial comprising an intensive arm, a less intensive arm and a control arm. SETTING: Community setting in South Wales and the East Midlands. PARTICIPANTS: Individuals aged 18-70 years with a current or previous BMI of >/= 30 kg/m(2) who could provide evidence of at least 5% weight loss during the previous 12 months. INTERVENTION: Participants received individually tailored MI, which included planning and self-monitoring. The intensive arm received six face-to-face sessions followed by nine telephone sessions. The less intensive arm received two face-to-face sessions followed by two telephone sessions. The control arm received a leaflet advising them on healthy lifestyle. MAIN OUTCOME MEASURES: Feasibility outcomes included numbers recruited, retention and adherence. The primary effectiveness outcome was BMI at 12 months post randomisation. Secondary outcomes included waist circumference, waist-to-hip ratio, physical activity, proportion maintaining weight loss, diet, quality of life, health service resource usage, binge eating and well-being. A process evaluation assessed intervention delivery, adherence, and participants' and practitioners' views. Economic analysis aimed to assess cost-effectiveness in terms of quality-adjusted life-years (QALYs). RESULTS: A total of 170 participants were randomised. Retention was good (84%) and adherence was excellent (intensive, 83%; less intensive, 91%). The between-group difference in mean BMI indicated the intensive arm had BMIs 1.0 kg/m(2) lower than the controls [95% confidence interval (CI) -2.2 kg/m(2) to 0.2 kg/m(2)]. Similarly, a potential difference was found in weight (average difference of 2.8 kg, 95% CI -6.1 kg to 0.5 kg). The intensive arm had odds of maintaining on average 43% [odds ratio(OR) 1.4, 95% CI 0.6 to 3.5] higher than controls. None of these findings were statistically significant. Further analyses controlling for level of adherence indicated that average BMI was 1.2 kg/m(2) lower in the intensive arm than the control arm (95% CI -2.5 kg/m(2) to 0.0 kg/m(2)). The intensive intervention led to a statistically significant difference in weight (mean -3.7 kg, 95% CI -7.1 kg to -0.3 kg). The other secondary outcomes showed limited evidence of differences between groups. The intervention was delivered as planned, and both practitioners and participants were positive about the intervention and its impact. Although not powered to assess cost-effectiveness, results of this feasibility study suggest that neither intervention as currently delivered is likely to be cost-effective in routine practice. CONCLUSION: This is the first trial of an intervention for WLM in the UK, the intervention is feasible and acceptable, and retention and adherence were high. The main effectiveness outcome showed a promising mean difference in the intensive arm. Owing to the small sample size, we are limited in the conclusions we can draw. However, findings suggest that the intensive intervention may facilitate long-term weight maintenance and, therefore, further testing in an effectiveness trial may be indicated. Research examining WLM is in its infancy, further research is needed to develop our understanding of WLM and to expand theory to inform the development of interventions to be tested in rigorously designed RCTs with cost-effectiveness assessed. TRIAL REGISTRATION: Current Controlled Trials ISRCTN35774128. FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 50. See the NIHR Journals Library website for further project information.","Health Technol Assess 19(Number): v-vi, xix-xxv, 1-378","UK",2015,"Various","Unspecified",null,"Adults","CUA","RCT","UK","Adults","Various","Unspecified","CUA","RCT",null,"2015:2015"]
[79,"Sjostrom, M., et al. (2015). \"Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence.\" Neurourol Urodyn 34(3): 244-250.",null,"Sjostrom, M., et al.","Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence","AIMS: To perform a deterministic cost-utility analysis, from a 1-year societal perspective, of two treatment programs for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post. The treatments were compared with each other and with no treatment. METHODS: We performed this economic evaluation alongside a randomized controlled trial. The study included 250 women aged 18-70, with SUI >/= 1 time/week, who were randomized to 3 months of pelvic floor muscle training via either an Internet-based program including e-mail support from an urotherapist (n = 124) or a program sent by post (n = 126). Recruitment was web-based, and participants were self-assessed with validated questionnaires and 2-day bladder diaries, supplemented by a telephone interview with a urotherapist. Treatment costs were continuously registered. Data on participants' time for training, incontinence aids, and laundry were collected at baseline, 4 months, and 1 year. We also measured quality of life with the condition-specific questionnaire ICIQ-LUTSqol, and calculated the quality-adjusted life-years (QALYs) gained. Baseline data remained unchanged for the no treatment option. Sensitivity analysis was performed. RESULTS: Compared to the postal program, the extra cost per QALY for the Internet-based program ranged from 200euro to 7,253euro, indicating greater QALY-gains at similar or slightly higher costs. Compared to no treatment, the extra cost per QALY for the Internet-based program ranged from 10,022euro to 38,921euro, indicating greater QALY-gains at higher, but probably acceptable costs. CONCLUSION: An Internet-based treatment for SUI is a new, cost-effective treatment alternative.","Neurourol Urodyn 34(Number): 244-250","Europe",2015,"Various","Home Based Training",null,"Adults","CUA","RCT","Europe","Adults","Various","Home Based Training","CUA","RCT",null,"2015:2015"]
[80,"Sopina, E., et al. (2017). \"Cost-effectiveness of a randomised trial of physical activity in Alzheimer's disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark.\" BMJ Open 7(6): e015217.",null,"Sopina, E., et al.","Cost-effectiveness of a randomised trial of physical activity in Alzheimer's disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark","OBJECTIVES: To explore the cost-effectiveness of a supervised moderate-to-high intensity aerobic exercise programme in people diagnosed with Alzheimer's disease (AD) and estimate incremental cost-effectiveness ratios (ICER) using participant-reported and proxy-reported measures of health-related quality of life (HRQoL) DESIGN: A cost-effectiveness analysis of economic and HRQoL data from a randomised trial delivered over 16 weeks. SETTING: Memory clinics in Denmark. PARTICIPANTS: 200 individuals with mild AD aged 50-90 years gave informed consent to participate in the study. Participants were randomised to control or intervention group. INTERVENTIONS: Control group received treatment as usual. The intervention group performed 1 hour of supervised moderate-to-high intensity aerobic exercise three times weekly for 16 weeks. PRIMARY AND SECONDARY OUTCOMES MEASURES: Different physical, functional and health measures were obtained at inclusion (baseline) and 4 and 16 weeks after. HRQoL (EuroQol-5 Dimensions-5 Levels/EQ-Visual Analogue Scale) was reported by the participants and the primary caregivers as proxy respondents. Differences in HRQOL as reported by the participant and caregiver were explored as were different values of caregiver time with respite from care tasks. RESULTS: The intervention cost was estimated at euro608 and euro496 per participant, with and without transport cost, respectively. Participants and caregivers in the intervention group reported a small, positive non-significant improvement in EQ-5D-5L and EQ-VAS after 16 weeks. The ICER was estimated at euro72 000/quality-adjusted life year using participant-reported outcomes and euro87000 using caregiver-reported outcomes. CONCLUSIONS: The findings suggest that the exercise intervention is unlikely to be cost-effective within the commonly applied threshold values. The cost of the intervention might be offset by potential savings from reduction in use of health and social care. TRIAL REGISTRATION NUMBER: https://clinicaltrials.gov/ct2/show/NCT01681602.","BMJ Open 7(Number): e015217","Denmark",2017,"Dementia","Aerobic Training",null,"Adults,Elderly","CUA","RCT","Denmark","Adults,Elderly","Dementia","Aerobic Training","CUA","RCT",null,"2017:2018"]
[81,"Sutherland, R., et al. (2016). \"Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the 'Physical Activity 4 Everyone' cluster randomized trial.\" Int J Behav Nutr Phys Act 13: 94.",null,"Sutherland, R., et al.","Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the 'Physical Activity 4 Everyone' cluster randomized trial","BACKGROUND: Few school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent populations. As a result, few cost effectiveness analyses have been reported. The aim of this paper is to report the cost and cost effectiveness of the Physical Activity 4 Everyone (PA4E1) intervention which was a multi-component intervention implemented in secondary schools located in low-income communities. Cost effectiveness was assessed using both the physical activity and weight status trial outcomes. METHODS: Intervention and Study Design: The PA4E1 cluster randomised controlled trial was implemented in 10 Australian secondary schools (5 intervention: 5 control) and consisted of intervention schools receiving seven physical activity promotion strategies and six additional strategies that supported school implementation of the intervention components. Costs associated with physical activity strategies, and intervention implementation strategies within the five intervention schools were estimated and compared to the costs of usual physical activity practices of schools in the control group. The total cost of implementing the intervention was estimated from a societal perspective, based on the number of enrolled students in the target grade at the start of the intervention (Grade 7, n = 837). Economic Outcomes: The economic analysis outcomes were cost and incremental cost effectiveness ratios for the following: minutes of moderate-to-vigorous physical activity (MVPA) per day gained, MET hours gained per person/day; Body Mass Index (BMI) unit avoided; and 10% reduction in BMI z-score. RESULTS: The intervention cost AUD $329,952 over 24 months, or AUD$394 per student in the intervention group. This resulted in a cost effectiveness ratio of AUD$56 ($35-$147) per additional minute of MVPA, AUD$1 ($0.6-$2.7) per MET hour gained per person per day, AUD$1408 ($788-$6,570) per BMI unit avoided, and AUD$563 ($282-$3,942) per 10% reduction in BMI z-score. CONCLUSION: PA4E1 is a cost effective intervention for increasing the physical activity levels and reducing unhealthy weight gain in adolescence, a period in which physical activity typically declines. Additional modelling could explore the potential economic impact of the intervention on morbidity and mortality. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000382875.","Int J Behav Nutr Phys Act 13(Number): 94","Australia",2016,"None","Unspecified",null,"Adolescents","CEA","RCT","Australia","Adolescents","None","Unspecified","CEA","RCT",null,"2016:2016"]
[82,"Swank, M. F., et al. (2015). \"Using frameworks to diagram value in complex policy and environmental interventions to prevent childhood obesity.\" J Public Health Manag Pract 21 Suppl 3: S116-120.",null,"Swank, M. F., et al.","Using frameworks to diagram value in complex policy and environmental interventions to prevent childhood obesity","BACKGROUND: To date, few tools assist policy makers and practitioners in understanding and conveying the implementation costs, potential impacts, and value of policy and environmental changes to address healthy eating, active living, and childhood obesity. For the Evaluation of Healthy Kids, Healthy Communities (HKHC), evaluators considered inputs (resources and investments) that generate costs and savings as well as benefits and harms related to social, economic, environmental, and health-related outcomes in their assessment of 49 HKHC community partnerships funded from 2009 to 2014. METHODS: Using data collected through individual and group interviews and an online performance monitoring system, evaluators created a socioecological framework to assess investments, resources, costs, savings, benefits, and harms at the individual, organizational, community, and societal levels. Evaluators customized frameworks for 6 focal strategies: active transportation, parks and play spaces, child care physical activity standards, corner stores, farmers' markets, and child care nutrition standards. RESULTS: To illustrate the Value Frameworks, this brief highlights the 38 HKHC communities implementing at least 1 active transportation strategy. Evaluators populated this conceptual Value Framework with themes from the strategy-specific inputs and outputs. The range of factors corresponding to the implementation and impact of the HKHC community partnerships are highlighted along with the inputs and outputs. CONCLUSIONS: The Value Frameworks helped evaluators identify gaps in current analysis models (ie, benefit-cost analysis, cost-effectiveness analysis) as well as paint a more complete picture of value for potential obesity prevention strategies. These frameworks provide a comprehensive understanding of investments needed, proposed costs and savings, and potential benefits and harms associated with economic, social, environmental, and health outcomes. This framing also allowed evaluators to demonstrate the interdependence of each socioecological level on the others in these multicomponent interventions. This model can be used by practitioners and community leaders to assess realistic and sustainable strategies to combat childhood obesity.","J Public Health Manag Pract 21 Suppl 3(Number): S116-120","Unclear",2015,"Various","Unspecified",null,"Children","CBA","Cohort","Unclear","Children","Various","Unspecified","CBA","Cohort",null,"2015:2015"]
[83,"Taddei, C., et al. (2015). \"Cycling promotion and non-communicable disease prevention: health impact assessment and economic evaluation of cycling to work or school in Florence.\" PLoS One 10(4): e0125491.",null,"Taddei, C., et al.","Cycling promotion and non-communicable disease prevention: health impact assessment and economic evaluation of cycling to work or school in Florence","OBJECTIVE: To estimate the effects of cycling promotion on major non-communicable diseases (NCDs) and costs from the public healthcare payer's perspective. DESIGN: Health impact assessment and economic evaluation using a dynamic model over a ten-year period and according to two cycling promotion scenarios. SETTING: Cycling to work or school in Florence, Italy. POPULATION: All individuals aged 15 and older commuting to work or school in Florence. MAIN OUTCOME MEASURES: The primary outcome measures were changes in NCD incidence and healthcare direct costs for the Tuscany Regional Health Service (SST) due to increased cycling. The secondary outcome was change in road traffic accidents. RESULTS: Increasing cycling modal share in Florence from 7.5% to about 17% (Scenario 1) or 27% (Scenario 2) could decrease the incidence of type 2 diabetes by 1.2% or 2.5%, and the incidence of acute myocardial infarction (AMI) and stroke by 0.6% or 1.2%. Within 10 years, the number of cases that can be prevented is 280 or 549 for type 2 diabetes, 51 or 100 for AMI, and 51 or 99 for stroke in Scenario 1 or Scenario 2, respectively. Average annual discounted savings for the SST are estimated to amount to euro400,804 or euro771,201 in Scenario 1 or Scenario 2, respectively. In Florence, due to the high use of vulnerable motorized vehicles (such as scooters, mopeds, and motorcycles), road traffic accidents are expected to decline in both our scenarios. Sensitivity analyses showed that health benefits and savings for the SST are substantial, the most sensitive parameters being the relative risk estimates of NCDs and active commuting. CONCLUSIONS: Effective policies and programs to promote a modal shift towards cycling among students and workers in Florence will contribute to reducing the NCD burden and helping long-term economic sustainability of the SST.","PLoS One 10(Number): e0125491","Italy",2015,"Various","Cycling",null,"Adults","CBA","Cohort","Italy","Adults","Various","Cycling","CBA","Cohort",null,"2015:2015"]
[84,"Tan, S. S., et al. (2016). \"Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care.\" Osteoarthritis Cartilage 24(4): 581-588.",null,"Tan, S. S., et al.","Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care","OBJECTIVE: To determine the cost-effectiveness (CE) of exercise therapy (intervention group) compared to 'general practitioner (GP) care' (control group) in patients with hip osteoarthritis (OA) in primary care. METHOD: This cost-utility analysis was conducted with 120 GPs in the Netherlands from the societal and healthcare perspective. Data on direct medical costs, productivity costs and quality of life (QoL) was collected using standardised questionnaires which were sent to the patients at baseline and at 6, 13, 26, 39 and 52 weeks follow-up. All costs were based on Euro 2011 cost data. RESULTS: A total of 203 patients were included. The annual direct medical costs per patient were significantly lower for the intervention group (euro 1233) compared to the control group (euro 1331). The average annual societal costs per patient were lower in the intervention group (euro 2634 vs euro 3241). Productivity costs were higher than direct medical costs. There was a very small adjusted difference in QoL of 0.006 in favour of the control group (95% CI: -0.04 to +0.02). CONCLUSION: Our study revealed that exercise therapy is probably cost saving, without the risk of noteworthy negative health effects. TRIAL REGISTRATION NUMBER: NTR1462.","Osteoarthritis Cartilage 24(Number): 581-588","Netherlands",2016,"Musculoskeletal","Unspecified",null,"Unspecified","CUA","Cohort","Netherlands","Unspecified","Musculoskeletal","Unspecified","CUA","Cohort",null,"2016:2016"]
[85,"Tsiachristas, A., et al. (2015). \"Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands.\" Value Health 18(8): 977-986.",null,"Tsiachristas, A., et al.","Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands","BACKGROUND: Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in The Netherlands to improve care and patient's health behavior. OBJECTIVE: The aim of this study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice. METHODS: We compared the physical activity, smoking status, quality-adjusted life-years, and yearly costs per patient between the most and the least comprehensive DMPs in four disease categories: primary CVR prevention, secondary CVR prevention, both types of CVR prevention, and COPD (N = 1034). Propensity score matching increased comparability between DMPs. A 2-year cost-utility analysis was performed from the health care and societal perspectives. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on cost-effectiveness. RESULTS: Patients in the most comprehensive DMPs increased their physical activity more (except for primary CVR prevention) and had higher smoking cessation rates. The incremental QALYs ranged from -0.032 to 0.038 across all diseases. From a societal perspective, the most comprehensive DMPs decreased costs in primary CVR prevention (certainty 57%), secondary CVR prevention (certainty 88%), and both types of CVR prevention (certainty 98%). Moreover, the implementation of comprehensive DMPs led to QALY gains in secondary CVR prevention (certainty 92%) and COPD (certainty 69%). CONCLUSIONS: The most comprehensive DMPs for CVR and COPD have the potential to be cost saving, effective, or cost-effective compared with the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions that is most suited for each target group.","Value Health 18(Number): 977-986","Netherlands",2015,"Respiratory, Cardiovascular","Various",null,"Unspecified","CUA","Cohort","Netherlands","Unspecified","Respiratory","Various","CUA","Cohort",null,"2015:2015"]
[86,"van Boven, J. F., et al. (2016). \"Effects of targeting disease and medication management interventions towards patients with COPD.\" Curr Med Res Opin 32(2): 229-239.",null,"van Boven, J. F., et al.","Effects of targeting disease and medication management interventions towards patients with COPD","OBJECTIVE: Suboptimal adherence in chronic obstructive pulmonary disease (COPD) patients is associated with decreased clinical and economic outcomes. Intervention programs, targeted at patients with suboptimal adherence and exacerbations, offer opportunities for cost-effective COPD care. We have aimed to assess the effects of the Medication Monitoring and Optimization (MeMO) targeted COPD intervention. METHODS: Twenty community pharmacies participated in this 1 year real-world study with a pre-test/post-test design. Patients with a physician-confirmed COPD diagnosis, oral corticosteroid use, suboptimal adherence and Clinical COPD Questionnaire (CCQ) score >/=1 were selected by pharmacists. Pharmacy interventions included inhalation instruction, medication information and motivational interviewing regarding adherence and smoking cessation. Proposals for dose, medication and/or inhaler change and physical activity or diet recommendations were discussed with the general practitioner (GP), physiotherapist or dietician, when deemed relevant. Primary endpoint was the change in CCQ score. Secondary outcomes were adherence, exacerbations, healthcare utilization, quality of life (EQ-5D), modified Medical Research Council (mMRC) dyspnea score and cost-effectiveness. RESULTS: Interventions were performed in 88 patients (mean age: 69; 52% male; mean CCQ: 2.10). The most often performed interventions were inhalation instruction (89%), medication education (98%) and adherence counseling (58%). Respectively 9%, 45% and 16% were referred to GP, physiotherapist or dietician. After 1 year, mean CCQ decrement was 0.12 and 38% showed a clinically relevant improvement. There was a significant decrease in exacerbations (-0.82) per patient per year. Adherence, mMRC and EQ-5D hardly changed. Per patient, annual medication costs were euro26 higher, interventions cost euro33, but total healthcare costs were euro333 lower. The small sample size and lack of a control group were the main limitations. CONCLUSION: By specifically targeting COPD patients with potential room for improvement, the MeMO COPD program has the potential to be an effective and cost-saving method for preventing exacerbations. However, no effects on quality of life have been observed. Larger studies are therefore recommended.","Curr Med Res Opin 32(Number): 229-239","Netherlands",2016,"Respiratory","Unspecified",null,"Elderly","CUA","Cohort","Netherlands","Elderly","Respiratory","Unspecified","CUA","Cohort",null,"2016:2016"]
[87,"van den Houten, M. M., et al. (2016). \"Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication.\" Br J Surg 103(12): 1616-1625.",null,"van den Houten, M. M., et al.","Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication","BACKGROUND: Current guidelines recommend supervised exercise therapy (SET) as the preferred initial treatment for patients with intermittent claudication. The availability of SET programmes is, however, limited and such programmes are often not reimbursed. Evidence for the long-term cost-effectiveness of SET compared with endovascular revascularization (ER) as primary treatment for intermittent claudication might aid widespread adoption in clinical practice. METHODS: A Markov model was constructed to determine the incremental costs, incremental quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio of SET versus ER for a hypothetical cohort of patients with newly diagnosed intermittent claudication, from the Dutch healthcare payer's perspective. In the event of primary treatment failure, possible secondary interventions were repeat ER, open revascularization or major amputation. Data sources for model parameters included original data from two RCTs, as well as evidence from the medical literature. The robustness of the results was tested with probabilistic and one-way sensitivity analysis. RESULTS: Considering a 5-year time horizon, probabilistic sensitivity analysis revealed that SET was associated with cost savings compared with ER (-euro6412, 95 per cent credibility interval (CrI) -euro11 874 to -euro1939). The mean difference in effectiveness was -0.07 (95 per cent CrI -0.27 to 0.16) QALYs. ER was associated with an additional euro91 600 per QALY gained compared with SET. One-way sensitivity analysis indicated more favourable cost-effectiveness for ER in subsets of patients with low quality-of-life scores at baseline. CONCLUSION: SET is a more cost-effective primary treatment for intermittent claudication than ER. These results support implementation of supervised exercise programmes in clinical practice.","Br J Surg 103(Number): 1616-1625","Netherlands",2016,"Cardiovascular","Supervised Exercise Therapy",null,"Unspecified","CUA","Cohort","Netherlands","Unspecified","Cardiovascular","Supervised Exercise Therapy","CUA","Cohort",null,"2016:2016"]
[88,"van der Velde, G., et al. (2016). \"Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.\" Spine J 16(12): 1582-1597.",null,"van der Velde, G., et al.","Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration","BACKGROUND CONTEXT: Whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD) are prevalent conditions that impact society and impose a significant economic burden on health-care systems. Health economic evidence on WAD and NAD interventions has been sparse: only three economic evaluations of interventions for NAD were identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (NPTF). An updated overview is needed to inform health-care policy and guidelines. PURPOSE: This study aimed to determine the cost-effectiveness of interventions for grades I-III WAD and NAD in children and adults. STUDY DESIGN: Systematic review of health economic literature, best-evidence synthesis. METHODS: We systematically searched CINAHL, the Cochrane economic databases (Health Technology Assessment, NHS Economic Evaluation Database), EconLit, EMBASE, MEDLINE, PsycINFO, and Tufts CEA Registry from 2000 to 2015 for economic evaluations of WAD and NAD interventions. We appraised relevant evaluations using the Scottish Intercollegiate Guidelines Network Methodology Criteria for Economic Evaluations. We extracted data, including mean costs (standardized to 2013 Canadian dollars [CAD]) and quality-adjusted life years (QALYs), from studies with adequate methodological quality. We recalculated cost-effectiveness statistics based on the standardized currency using a willingness-to-pay of CAD $50,000 per additional QALY. Funding was provided by the Ministry of Finance. RESULTS: Our search identified 1,616 citations. Six studies fulfilled our selection criteria, including three studies previously reviewed by the NPTF. Structured education appears cost-effective for adults with WAD. For adults with NAD, acupuncture added to routine medical care; manual therapy; multimodal care that includes manual therapy; advice and exercise; and psychological care using cognitive-behavioral therapy appear cost-effective. In contrast, adding manual therapy or diathermy to advice and exercise; multimodal care by a physiotherapist or physician; and behavioral-graded activity do not appear cost-effective for adults with NAD. CONCLUSIONS: Our review adds to the findings of the NPTF. Recent evidence suggests that structured education is cost-effective for WAD, whereas advice and exercise and multimodal care that include manual therapy are cost-effective for NAD. Obtaining more robust health economic evidence for non-invasive interventions for WAD and NAD in children and adults remains an essential research priority.","Spine J 16(Number): 1582-1597","Canada",2016,"Musculoskeletal","Unspecified",null,"Children,Adults","CUA","SLR","Canada","Children,Adults","Musculoskeletal","Unspecified","CUA","SLR",null,"2016:2016"]
[89,"Veerman, J. L., et al. (2016). \"Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study.\" BMJ Open 6(9): e011617.",null,"Veerman, J. L., et al.","Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study","BACKGROUND: Studies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking. METHODS: Using data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years. RESULTS: Installing and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness. CONCLUSIONS: In low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might consider a more comprehensive assessment of its social value (eg, social cohesion, safety and air quality).","BMJ Open 6(Number): e011617","Australia",2016,"None","Walking",null,"Adults","CUA","Cohort","Australia","Adults","None","Walking","CUA","Cohort",null,"2016:2016"]
[90,"Verhoef, T. I., et al. (2016). \"Cost-effectiveness of a physical exercise programme for residents of care homes: a pilot study.\" BMC Geriatr 16: 83.",null,"Verhoef, T. I., et al.","Cost-effectiveness of a physical exercise programme for residents of care homes: a pilot study","BACKGROUND: Oomph! Wellness organises interactive exercise and activity classes (Oomph! classes) for older people in care homes. We investigated the cost-effectiveness of Oomph! classes. METHODS: Health-related quality of life was measured using the EQ-5D-5 L questionnaire at three time points; 3 months and 1 week prior to the start of the classes and after 3 months of Oomph! classes. Costs included the costs of organising the classes, training instructors and health service use (General Practitioner (GP) and hospital outpatient visits). To determine the cost-effectiveness of Oomph! classes, total costs and quality-adjusted life-years (QALYs) during the 3 months after initiation of the classes were compared to the total costs and QALYs of the 3 months prior to the classes and extrapolated to a 1-year time horizon. Uncertainty was taken into account using one-way and probabilistic sensitivity analysis. RESULTS: Sixteen residents completed all three EQ-5D-5 L questionnaires. There was a decrease in mean health related quality of life per participant in the 3 months before Oomph! classes (0.56 to 0.52, p = 0.26) and an increase in the 3 months after the start of Oomph! classes (0.52 to 0.60, p = 0.06), but the changes were not statistically significant. There were more GP visits after the start of Oomph! classes and fewer hospital outpatient visits, leading to a slight decrease in NHS costs (mean pound132 vs pound141 per participant), but the differences were not statistically significant (p = 0.79). In the base case scenario, total costs for Oomph! classes were pound113 higher per participant than without Oomph! classes ( pound677 vs pound564) and total QALYs were 0.074 higher (0.594 vs 0.520). The incremental costs per QALY gained were therefore pound1531. The 95 % confidence intervals around the cost/QALY gained varied from dominant to dominated, meaning there was large uncertainty around the cost-effectiveness results. Given a willingness to pay threshold of pound20,000 per QALY gained, Oomph! classes had a 62 %-86 % probability of being cost-effective depending on the scenario used. CONCLUSIONS: Preliminary evidence suggests that Oomph! classes may be cost-effective, but further evidence is needed about its impact on health-related quality of life and health service use.","BMC Geriatr 16(Number): 83","UK",2016,"Various","Unspecified",null,"Elderly","CUA","Cohort","UK","Elderly","Various","Unspecified","CUA","Cohort",null,"2016:2016"]
[91,"Verhoef, T. I., et al. (2016). \"Cost-effectiveness analysis of offering free leisure centre memberships to physically inactive members of the public receiving state benefits: a case study.\" BMC Public Health 16: 616.",null,"Verhoef, T. I., et al.","Cost-effectiveness analysis of offering free leisure centre memberships to physically inactive members of the public receiving state benefits: a case study","BACKGROUND: We evaluated the cost-effectiveness of the Give-it-a-Go programme, which offers free leisure centre memberships to physically inactive members of the public in a single London Borough receiving state benefits. METHODS: A decision analytic Markov model was developed to analyse lifetime costs and quality-adjusted life-years (QALYs) of 1025 people recruited to the intervention versus no intervention. In the intervention group, people were offered 4 months of free membership at a leisure centre. Physical activity levels were assessed at 0 and 4 months using the International Physical Activity Questionnaire (IPAQ). Higher levels of physical activity were assumed to decrease the risk of coronary heart disease, stroke and diabetes mellitus type II, as well as improve mental health. Costs were assessed from a National Health Service (NHS) perspective. Uncertainty was assessed using one-way and probabilistic sensitivity analyses. RESULTS: One-hundred fifty nine participants (15.5 %) completed the programme by attending the leisure centre for 4 months. Compared with no intervention, Give it a Go increased costs by pound67.25 and QALYs by 0.0033 (equivalent to 1.21 days in full health) per recruited person. The incremental costs per QALY gained were pound20,347. The results were highly sensitive to the magnitude of mental health gain due to physical activity and the duration of the effect of the programme (1 year in the base case analysis). When the mental health gain was omitted from the analysis, the incremental cost per QALY gained increased to almost pound1.5 million. In the probabilistic sensitivity analysis, the incremental costs per QALY gained were below pound20,000 in 39 % of the 5000 simulations. CONCLUSIONS: Give it a Go did not significantly increase life-expectancy, but had a positive influence on quality of life due to the mental health gain of physical activity. If the increase in physical activity caused by Give it a Go lasts for more than 1 year, the programme would be cost-effective given a willingness to pay for a QALY of pound20,000.","BMC Public Health 16(Number): 616","UK",2016,"None","Unspecified",null,"Any","CUA","Cohort","UK","Any","None","Unspecified","CUA","Cohort",null,"2016:2016"]
[92,"Walsh, T. S., et al. (2015). \"Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial.\" JAMA Intern Med 175(6): 901-910.",null,"Walsh, T. S., et al.","Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial","IMPORTANCE: Critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. OBJECTIVE: To evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post-intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. DESIGN, SETTING, AND PARTICIPANTS: A parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. INTERVENTIONS: During the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. MAIN OUTCOMES AND MEASURES: The Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). RESULTS: Median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, -0.2 [95% CI, -1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, -0.1 [95% CI, -3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, -3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. CONCLUSIONS AND RELEVANCE: Post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery. TRIAL REGISTRATION: isrctn.com Identifier: ISRCTN09412438.","JAMA Intern Med 175(Number): 901-910","UK",2015,"Various","Physiotherapy",null,"Any","CUA","RCT","UK","Any","Various","Physiotherapy","CUA","RCT",null,"2015:2015"]
[93,"Wang, H., et al. (2017). \"Cost-Effectiveness of Ready for Recess to Promote Physical Activity in Children.\" J Sch Health 87(4): 278-285.",null,"Wang, H., et al.","Cost-Effectiveness of Ready for Recess to Promote Physical Activity in Children","BACKGROUND: Many school-based recess interventions have been shown to be effective in increasing physical activity but their relative efficiency compared to other school-based programs are unknown. This study examined the cost-effectiveness of Ready for Recess, a program designed to increase students' physical activity in 2 elementary schools. METHODS: Standard cost-effectiveness analysis method was used from a program's perspective for this study. Program effectiveness was measured as total metabolic equivalent (MET) hours gained. Program costs included equipment, training, and personnel costs during the 1-year intervention. The cost-effectiveness was measured as the ratio of program costs to total MET-hours gained. RESULTS: Ready for Recess cost $27,643.97 for the 2 schools in the first year of implementation. Physical activity increased by 1.8 MET-hours per day per student. Approximately 32 cents were spent on Ready for Recess to produce an additional MET-hour per student per school day in the 2008-2009 school year. CONCLUSIONS: Ready for Recess was cost-effective in its first year of implementation using 35 cents as a benchmark and it was cost-effective relative to other school-based physical activity interventions. The program may be more cost-effective if implemented for a longer time and on a larger scale.","J Sch Health 87(Number): 278-285","USA",2017,"None","Multiple",null,"Children","CEA","Cohort","USA","Children","None","Multiple","CEA","Cohort",null,"2017:2018"]
[94,"Whelan, M. E., et al. (2016). \"Feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss program delivered via a hospital outpatient setting.\" Transl Behav Med 6(3): 386-395.",null,"Whelan, M. E., et al.","Feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss program delivered via a hospital outpatient setting","Engaging patients in a group-based weight loss program is a challenge for the acute-care hospital outpatient setting. To evaluate the feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss service and an existing face-to-face, group-based service a non-randomised, two-arm feasibility trial was used. Patients who declined a two-month existing outpatient group-based program were offered a six-month research-based telephone program. Outcomes were assessed at baseline, two months (both groups) and six months (telephone program only) using paired t tests and linear regression models. Cost per healthy life year gained was calculated for both programs. The telephone program achieved significant weight loss (-4.1 +/- 5.0 %; p = 0.001) for completers (n = 35; 57 % of enrolees) at six months. Compared to the group-based program (n = 33 completers; 66 %), the telephone program was associated with greater weight loss (mean difference [95%CI] -2.0 % [-3.4, -0.6]; p = 0.007) at two months. The cost per healthy life year gained was $33,000 and $85,000, for the telephone and group program, respectively. Telephone-delivered weight management services may be effective and cost-effective within an acute-care hospital setting, likely more so than usual (group-based) care.","Transl Behav Med 6(Number): 386-395","Australia",2016,"Various","Unspecified",null,"Unspecified","CEA","Cohort","Australia","Unspecified","Various","Unspecified","CEA","Cohort",null,"2016:2016"]
[95,"Williams, M. A., et al. (2015). \"Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation.\" Health Technol Assess 19(19): 1-222.",null,"Williams, M. A., et al.","Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation","BACKGROUND: The effectiveness of exercise for improving hand and wrist function in people with rheumatoid arthritis (RA) is uncertain. OBJECTIVES: The study aims were (1) to estimate the clinical effectiveness and cost-effectiveness of adding an optimised exercise programme for hands and upper limbs to standard care for patients with RA; and (2) to qualitatively describe the experience of participants in the trial with a particular emphasis on acceptability of the intervention, exercise behaviours and reasons for adherence/non-adherence. DESIGN: A pragmatic, multicentred, individually randomised controlled trial with an embedded qualitative study. Outcome assessors were blind to group assignment and independent of treatment delivery. SETTING: Seventeen NHS trusts in England comprising 21 rheumatology and therapy departments. PARTICIPANTS: Adults with RA who had pain and dysfunction of the hands and/or wrists and had been on stable medication for at least 3 months. Patients were excluded if they were under 18 years old, had undergone upper limb surgery/fracture in the last 6 months, were on a waiting list for upper limb surgery or were pregnant. INTERVENTIONS: Usual care or usual care plus an individualised exercise programme. Usual care consisted of joint protection education, general exercise advice and functional splinting if required. The exercise programme consisted of six sessions of strengthening and stretching exercises with a hand therapist, daily home exercises and strategies to maximise adherence. MAIN OUTCOME MEASURES: The primary outcome was the Michigan Hand Outcome Questionnaire (MHQ) overall hand function subscale score at 12 months. Secondary outcome measures included the full MHQ, pain, health-related quality of life (Short Form questionnaire-12 items), impairment (grip strength, dexterity and range of motion) and self-efficacy. European Quality of Life-5 Dimensions, medication and health-care use were collected for the health economics evaluation. Follow-up was at 4 and 12 months post randomisation. Analysis was performed on an intention-to-treat basis. RESULTS: We randomised 490 patients (244 to usual care, 246 to exercise programme). Compliance with the treatments was very good (93% of usual care participants and 75% of exercise programme participants completed treatment). Outcomes were obtained for 89% of participants at 12 months (222 for usual care, 216 for exercise programme). There was a statistically significant difference in favour of the exercise programme for the primary outcome at 4 and 12 months [mean difference 4.6 points, 95% confidence interval (CI) 2.2 to 7.0 points; and mean difference 4.4 points, 95% CI 1.6 to 7.1 points, respectively]. There were no significant differences in pain scores or adverse events. The estimated difference in mean quality-adjusted life-years (QALYs) accrued over 12 months was 0.01 greater (95% CI -0.03 to 0.05) in the exercise programme group. Imputed analysis produced incremental cost-effectiveness ratio estimates of pound17,941 (0.59 probability of cost-effectiveness at willingness-to-pay threshold of pound30,000 per QALY). The qualitative study found the exercise programme to be acceptable and highlighted the importance of the therapist in enabling patients to establish a routine and incorporate the exercises into their lives. CONCLUSIONS: The results of the Strengthening And stretching for Rheumatoid Arthritis of the Hand trial suggest that the addition of an exercise programme for RA hands/wrists to usual care is clinically effective and cost-effective when compared with usual care alone. No adverse effects were associated with the exercise programme. The economic analysis suggests that the intervention is likely to be cost-effective. STUDY REGISTRATION: Current Controlled Trials ISRCTN 89936343.","Health Technol Assess 19(Number): 1-222","UK",2015,"Musculoskeletal","Strength and Stretch Hand",null,"Unspecified","CUA","RCT","UK","Unspecified","Musculoskeletal","Strength and Stretch Hand","CUA","RCT",null,"2015:2015"]
[96,"Wilson, K. J., et al. (2015). \"Cost-effectiveness of a community-based weight control intervention targeting a low-socioeconomic-status Mexican-origin population.\" Health Promot Pract 16(1): 101-108.",null,"Wilson, K. J., et al.","Cost-effectiveness of a community-based weight control intervention targeting a low-socioeconomic-status Mexican-origin population","INTRODUCTION: The objective of our study was to evaluate the cost-effectiveness of a community-based intervention designed to improve physical activity levels and dietary intake and to reduce diabetes risk in a largely Hispanic population residing along the U.S.-Mexico border. METHOD: We forecasted disease outcomes, quality-adjusted life-years (QALYs) gained, and lifetime costs associated with actual and projected attainment of 2% and 5% weight loss taking a societal cost perspective. We extrapolated changes in beverage calorie consumption between baseline and 6-month follow-up to attain projected weight loss measures. Outcomes were projected 5, 10, and 20 years into the future and discounted at a 3.0% rate. RESULTS: The incremental cost-effectiveness ratio was $57,430 and $61,893, respectively, per QALY gained when compared with usual care for the 2% and 5% weight loss scenarios. The intervention was particularly cost-effective for morbidly obese participants. Cost-effectiveness improves when using 3-year weight loss projections based on changes in sugar-sweetened beverage caloric consumption to $49,478 and $24,092 for the 2% and 5% weight loss scenarios. CONCLUSIONS: This analysis demonstrates that a culturally sensitive community-based weight loss and maintenance intervention can be cost-effective even when healthy weight individuals participate.","Health Promot Pract 16(Number): 101-108","USA",2015,"None","Unspecified",null,"Unspecified","CUA","Cohort","USA","Unspecified","None","Unspecified","CUA","Cohort",null,"2015:2015"]
[97,"Wright, D. R., et al. (2015). \"Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S.\" Am J Prev Med 49(1): 135-147.",null,"Wright, D. R., et al.","Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S","INTRODUCTION: Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities. METHODS: Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention's impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3% annually. Probabilistic sensitivity analyses simulated 95% uncertainty intervals (UIs) around outcomes. RESULTS: Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95% UI=$14.2, $134) million. The intervention is 94.7% likely to be cost saving by 2025. CONCLUSIONS: Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.","Am J Prev Med 49(Number): 135-147","USA",2015,"None","Unspecified",null,"Children","CEA","Cohort","USA","Children","None","Unspecified","CEA","Cohort",null,"2015:2015"]
[98,"Zapata-Diomedi, B., et al. (2016). \"The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia.\" Health Place 42: 19-29.",null,"Zapata-Diomedi, B., et al.","The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia","Attributes of the built environment can positively influence physical activity of urban populations, which results in health and economic benefits. In this study, we derived scenarios from the literature for the association built environment-physical activity and used a mathematical model to translate improvements in physical activity to health-adjusted life years and health care costs. We modelled 28 scenarios representing a diverse range of built environment attributes including density, diversity of land use, availability of destinations, distance to transit, design and neighbourhood walkability. Our results indicated potential health gains in 24 of the 28 modelled built environment attributes. Health care cost savings due to prevented physical activity-related diseases ranged between A$1300 to A$105,355 per 100,000 adults per year. On the other hand, additional health care costs of prolonged life years attributable to improvements in physical activity were nearly 50% higher than the estimated health care costs savings. Our results give an indication of the potential health benefits of investing in physical activity-friendly built environments.","Health Place 42(Number): 19-29","Australia",2016,"None","Unspecified",null,"Adults","CBA","Cohort","Australia","Adults","None","Unspecified","CBA","Cohort",null,"2016:2016"]
[99,"Zivin, K., et al. (2017). \"Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees.\" Am J Prev Med 52(3): 347-352.",null,"Zivin, K., et al.","Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees","INTRODUCTION: Employee wellness programs show mixed effectiveness results. This study examined the impact of an insurer's lifestyle modification program on healthcare costs of obese individuals. METHODS: This nonrandomized comparative effectiveness study evaluated changes in healthcare costs for participants in two incentivized programs, an Internet-mediated pedometer-based walking program (WalkingSpree, n=7,594) and an in-person weight-loss program (Weight Watchers, n=5,764). The primary outcome was the change in total healthcare costs from the baseline year to the year after program participation. Data were collected from 2009 to 2011 and the analysis was done in 2014-2015. RESULTS: After 1 year, unadjusted mean costs decreased in both programs, with larger decreases for Weight Watchers participants than WalkingSpree participants (-$1,055.39 vs -$577.10, p=0.019). This difference was driven by higher rates of women in Weight Watchers, higher baseline total costs among women, and a greater decrease in costs for women in Weight Watchers (-$1,037.60 vs -$388.50, p=0.014). After adjustment for baseline costs, there were no differences by program or gender. CONCLUSIONS: Comparable cost reductions in both programs suggest that employers may want to offer more than one choice of incentivized wellness program with monitoring to meet the diverse needs of employees.","Am J Prev Med 52(Number): 347-352","USA",2017,"Various","Walking",null,"Unspecified","CCA","Cohort","USA","Unspecified","Various","Walking","CCA","Cohort",null,"2017:2018"]
[100,"Zwerink, M., et al. (2016). \"Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management.\" Copd 13(2): 214-223.",null,"Zwerink, M., et al.","Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management","INTRODUCTION: Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up. METHODS: All included COPD patients participated in four self-management sessions. Additionally, patients in the COPE-active group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained 3 times/week for 6 months and two times/week during the subsequent 5 months. In both periods, one of these weekly training sessions was home-based (unsupervised). No formal physiotherapy sessions were offered to COPE-active patients in the second year. A decision analytical model with a 24-month perspective was used to evaluate cost-effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated and cost-effectiveness planes were created. RESULTS: Data of 77 patients participating in the exercise programme and 76 patients in the control group were analysed. The ICER for an additional patient prevented from deteriorating at least 47.5 meters on the ISWT was euro6257. The ICER for an additional patient with a clinically relevant improvement (>/= 500 steps/day) in physical activity was euro1564, and the ICER for an additional quality-adjusted life year (QALY) was euro10 950. CONCLUSION: Due to a lack of maintenance of beneficial effects on our primary outcome exercise capacity after 2 years of follow-up and higher costs of the programme, the community-based exercise programme cannot be considered cost-effective compared to self-management programmes only. Nevertheless, the ICERs for the secondary outcomes physical activity and QALY are generally considered acceptable.","Copd 13(Number): 214-223","Netherlands",2016,"Respiratory","Walking",null,"Unspecified","CEA,CUA","Cohort","Netherlands","Unspecified","Respiratory","Walking","CEA,CUA","Cohort",null,"2016:2016"]

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[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C10","C10","Disease categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1970,false,null,null,null,"",null,"Sweden","Physiotherapy",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sub-populations categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1971,false,null,null,null,"",null,"UK","Strength and Stretch Hand",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PRO tool categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972,false,null,null,null,"",null,"USA","Supervised Exercise Therapy",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,{"$f":"IF(CG14=\"\",\"\",CG14)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study type categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1973,false,null,null,null,"",null,"Unclear","Tai ji Quan",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodology categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1974,false,null,null,null,"",{"$f":"COLUMN()","v":87},null,"Texercise Select",null,null,null,null,null,null,null,null,null,""]
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