Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Br J Sports Med. 2011 Dec;45(15):1223-9. doi: 10.1136/bjsm.2010.072439. Epub 2010 Nov 16.
To assess the cost-effectiveness of exercise on prescription with ongoing support in general practice.
Prospective cost-effectiveness study undertaken as part of the 2-year Women's lifestyle study randomised controlled trial involving 1089 'less-active' women aged 40-74. The 'enhanced Green Prescription' intervention included written exercise prescription and brief advice from a primary care nurse, face-to-face follow-up at 6 months, and 9 months of telephone support. The primary outcome was incremental cost of moving one 'less-active' person into the 'active' category over 24 months. Direct costs of programme delivery were recorded. Other (indirect) costs covered in the analyses included participant costs of exercise, costs of primary and secondary healthcare utilisation, allied health therapies and time off work (lost productivity). Cost-effectiveness ratios were calculated with and without including indirect costs.
Follow-up rates were 93% at 12 months and 89% at 24 months. Significant improvements in physical activity were found at 12 and 24 months (p<0.01). The exercise programme cost was New Zealand dollars (NZ$) 93.68 (€45.90) per participant. There was no significant difference in indirect costs over the course of the trial between the two groups (rate ratios: 0.99 (95% CI 0.81 to 1.2) at 12 months and 1.01 (95% CI 0.83 to 1.23) at 24 months, p=0.9). Cost-effectiveness ratios using programme costs were NZ$687 (€331) per person made 'active' and sustained at 12 months and NZ$1407 (€678) per person made 'active' and sustained at 24 months.
This nurse-delivered programme with ongoing support is very cost-effective and compares favourably with other primary care and community-based physical activity interventions internationally.
评估在常规医疗实践中开具运动处方并提供持续支持的成本效益。
这是一项前瞻性成本效益研究，作为为期 2 年的女性生活方式研究的一部分，该研究为随机对照试验，涉及 1089 名年龄在 40-74 岁之间的“不活跃”女性。“增强型绿色处方”干预措施包括书面运动处方和初级保健护士的简要建议、6 个月时的面对面随访以及 9 个月的电话支持。主要结果是在 24 个月内将一名“不活跃”的人转移到“活跃”类别中的增量成本。记录了方案实施的直接成本。分析中还包括参与者的运动成本、初级和二级医疗保健利用、联合健康治疗和请假（失去生产力）等其他（间接）成本。计算了包括和不包括间接成本的成本效益比。
12 个月时的随访率为 93%，24 个月时为 89%。在 12 个月和 24 个月时发现身体活动有显著改善（p<0.01）。运动方案的每位参与者成本为新西兰元（NZ$）93.68（€45.90）。在试验过程中，两组之间的间接成本没有显著差异（12 个月时的比率比：0.99（95%CI 0.81-1.2），24 个月时为 1.01（95%CI 0.83-1.23），p=0.9）。使用方案成本的成本效益比在 12 个月时为每位参与者花费 NZ$687（€331）使他们保持“活跃”，在 24 个月时为每位参与者花费 NZ$1407（€678）使他们保持“活跃”。
这种由护士提供的方案，有持续支持，非常具有成本效益，与国际上其他初级保健和社区为基础的身体活动干预措施相比具有优势。
