Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial
Background: Mobility limitations in older populations have a substantial impact on health outcomes, quality of life, and social care costs. The Retirement in Action (REACT) randomised controlled trial assessed a 12-month community-based group physical activity and behaviour maintenance intervention to help prevent decline in physical functioning in older adults at increased risk of mobility limitation. We aimed to do an economic evaluation of the REACT trial to investigate whether the intervention is cost-effective. Methods: In this health economic evaluation, we did cost-effectiveness and cost-utility analyses of the REACT programme versus standard care on the basis of resource use, primary outcome, and health-related quality-of-life data measured in the REACT trial. We also developed a decision analytic Markov model that forecasts the mobility of recipients beyond the 24-month follow-up of the trial and translated this into future costs and potential benefit to health-related quality of life using the National Health Service and Personal Social Services perspective. Participants completed questionnaire booklets at baseline, and at 6, 12, and 24 months after randomisation, which included a resource use questionnaire and the EQ-5D-5L and 36-item short-form survey (SF-36) health-related quality-of-life instruments. The cost of delivering the intervention was estimated by identifying key resources, such as REACT session leader time, time of an individual to coordinate the programme, and venue hire. EQ-5D-5L and SF-36 responses were converted to preference-based utility values, which were used to estimate quality-adjusted life-years (QALYs) over the 24-month trial follow-up using the area-under-the-curve method. We used generalised linear models to examine the effect of the REACT programme on costs and QALYs and adjust for baseline covariates. Costs and QALYs beyond 12 months were discounted at 3·5% per year. This is a pre-planned analysis of the REACT trial; the trial itself is registered with ISRCTN (ISRCTN45627165). Findings: The 12-month REACT programme was estimated to cost £622 per recipient to deliver. The most substantial cost components are the REACT session leader time (£309 per participant), venue hire (£109), and the REACT coordinator time (£80). The base-case analysis of the trial-based economic evaluation showed that reductions in health and social care usage due to the REACT programme could offset the REACT delivery costs (£3943 in the intervention group vs £4043 in the control group; difference: –£103 [95% CI −£695 to £489]) with a health benefit of 0·04 QALYs (0·009–0·071; 1·354 QALYs in the intervention group vs 1·314 QALYs in the control group) within the 24-month timeframe of the trial. Interpretation: The REACT programme could be considered a cost-effective approach for improving the health-related quality of life of older adults at risk of mobility limitations. Funding: National Institute for Health Research Public Health Research Programme.
Citation
@article{t.m.2022,
author = {Snowsill, T. M. and Stathi, A. and Green, C. and Withall, J.
and Greaves, C. J. and Thompson, J. L. and Taylor, G. and Gray, S.
and Johansen-Berg, H. and Bilzon, J. L. J. and de Koning, J. L. and
Bollen, J. C. and Moorlock, S. J. and Western, M. J. and Guralnik,
J. M. and Rejeski, W. J. and Fox, K. R. and Medina-Lara, A.},
title = {Cost-Effectiveness of a Physical Activity and Behaviour
Maintenance Programme on Functional Mobility Decline in Older
Adults: An Economic Evaluation of the {REACT} {(Retirement} in
{Action)} Trial},
journal = {Lancet Public Health},
volume = {7},
number = {4},
pages = {e327 - e334},
date = {2022-03-01},
url = {https://tristansnowsill.co.uk/cost-effectiveness-of-a-physical-activity.html},
doi = {10.1016/S2468-2667(22)00030-5},
langid = {en},
abstract = {Background: Mobility limitations in older populations have
a substantial impact on health outcomes, quality of life, and social
care costs. The Retirement in Action (REACT) randomised controlled
trial assessed a 12-month community-based group physical activity
and behaviour maintenance intervention to help prevent decline in
physical functioning in older adults at increased risk of mobility
limitation. We aimed to do an economic evaluation of the REACT trial
to investigate whether the intervention is cost-effective. Methods:
In this health economic evaluation, we did cost-effectiveness and
cost-utility analyses of the REACT programme versus standard care on
the basis of resource use, primary outcome, and health-related
quality-of-life data measured in the REACT trial. We also developed
a decision analytic Markov model that forecasts the mobility of
recipients beyond the 24-month follow-up of the trial and translated
this into future costs and potential benefit to health-related
quality of life using the National Health Service and Personal
Social Services perspective. Participants completed questionnaire
booklets at baseline, and at 6, 12, and 24 months after
randomisation, which included a resource use questionnaire and the
EQ-5D-5L and 36-item short-form survey (SF-36) health-related
quality-of-life instruments. The cost of delivering the intervention
was estimated by identifying key resources, such as REACT session
leader time, time of an individual to coordinate the programme, and
venue hire. EQ-5D-5L and SF-36 responses were converted to
preference-based utility values, which were used to estimate
quality-adjusted life-years (QALYs) over the 24-month trial
follow-up using the area-under-the-curve method. We used generalised
linear models to examine the effect of the REACT programme on costs
and QALYs and adjust for baseline covariates. Costs and QALYs beyond
12 months were discounted at 3·5\% per year. This is a pre-planned
analysis of the REACT trial; the trial itself is registered with
ISRCTN (ISRCTN45627165). Findings: The 12-month REACT programme was
estimated to cost £622 per recipient to deliver. The most
substantial cost components are the REACT session leader time (£309
per participant), venue hire (£109), and the REACT coordinator time
(£80). The base-case analysis of the trial-based economic evaluation
showed that reductions in health and social care usage due to the
REACT programme could offset the REACT delivery costs (£3943 in the
intervention group vs £4043 in the control group; difference: –£103
{[}95\% CI −£695 to £489{]}) with a health benefit of 0·04 QALYs
(0·009–0·071; 1·354 QALYs in the intervention group vs 1·314 QALYs
in the control group) within the 24-month timeframe of the trial.
Interpretation: The REACT programme could be considered a
cost-effective approach for improving the health-related quality of
life of older adults at risk of mobility limitations. Funding:
National Institute for Health Research Public Health Research
Programme.}
}