Health Economics Research Group (HERG), Brunel University, , Uxbridge, Middlesex, UK.
Br J Sports Med. 2014 Feb;48(3):202-6. doi: 10.1136/bjsports-2013-092897. Epub 2013 Dec 18.
This study models the cost-effectiveness of brief advice (BA) in primary care for physical activity (PA) addressing the limitations in the current limited economic literature through the use of a time-based modelling approach.
A Markov model was used to compare the lifetime costs and outcomes of a cohort of 100 000 people exposed to BA versus usual care. Health outcomes were expressed in terms of quality-adjusted life years (QALYs). Costs were assessed from a health provider perspective (£2010/11 prices). Data to populate the model were derived from systematic literature reviews and the literature searches of economic evaluations that were conducted for national guidelines. Deterministic and probability sensitivity analyses explored the uncertainty in parameter estimates including short-term mental health gains associated with PA.
Compared with usual care, BA is more expensive, incurring additional costs of £806 809 but it is more effective leading to 466 QALYs gained in the total cohort, a QALY gain of 0.0047/person. The incremental cost per QALY of BA is £1730 (including mental health gains) and thus can be considered cost-effective at a threshold of £20 000/QALY. Most changes in assumptions resulted in the incremental cost-effectiveness ratio (ICER) falling at or below £12 000/QALY gained. However, when short-term mental health gains were excluded the ICER was £27 000/QALY gained. The probabilistic sensitivity analysis showed that, at a threshold of £20 000/QALY, there was a 99.9% chance that BA would be cost-effective.
BA is a cost-effective way to improve PA among adults, provided short-term mental health gains are considered. Further research is required to provide more accurate evidence on factors contributing to the cost-effectiveness of BA.
本研究通过使用基于时间的建模方法，对当前有限的经济文献中的局限性进行建模，以评估初级保健中针对身体活动（PA）的简短建议（BA）的成本效益。
使用马尔可夫模型比较了暴露于 BA 与常规护理的 100000 人队列的终生成本和结果。健康结果以质量调整生命年（QALY）表示。从卫生提供者的角度评估了成本（2010/11 年价格）。用于填充模型的数据来自系统文献综述和针对国家指南进行的经济评估的文献检索。确定性和概率敏感性分析探讨了参数估计的不确定性，包括与 PA 相关的短期心理健康收益。
与常规护理相比，BA 的成本更高，增加了 806809 英镑的额外成本，但它更有效，导致整个队列获得了 466 个 QALY，人均 QALY 增加了 0.0047。BA 的增量成本效益比（ICER）为 1730 英镑（包括心理健康收益），因此可以在 20000 英镑/QALY 的阈值下被认为是具有成本效益的。大多数假设变化导致增量成本效益比（ICER）降至或低于 12000 英镑/QALY 获得的水平。然而，当排除短期心理健康收益时，ICER 为 27000 英镑/QALY 获得。概率敏感性分析表明，在 20000 英镑/QALY 的阈值下，BA 具有 99.9%的可能性具有成本效益。
BA 是提高成年人 PA 的一种具有成本效益的方法，前提是考虑短期心理健康收益。需要进一步研究以提供更准确的证据，说明影响 BA 成本效益的因素。
