Cowper Patricia A, Peterson Matthew J, Pieper Carl F, Sloane Richard J, Hall Katherine S, McConnell Eleanor S, Bosworth Hayden B, Ekelund Carola C, Pearson Megan P, Morey Miriam C
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
J Am Geriatr Soc. 2017 Mar;65(3):533-539. doi: 10.1111/jgs.14567. Epub 2017 Feb 2.
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.
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.
Veterans Affairs Medical Center, Durham, North Carolina.
Male veterans aged ≥70 years (n = 398).
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.
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.
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.
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.
对一项基于初级保健的身体活动咨询干预措施进行经济评估，该干预措施提高了老年退伍军人的身体活动水平和快速步态速度。
随机试验的次要目标，该试验评估了运动咨询（相对于常规护理）对身体机能、身体活动、功能、残疾以及医疗资源使用和成本的影响。
北卡罗来纳州达勒姆的退伍军人事务医疗中心。
年龄≥70岁的男性退伍军人（n = 398）。
一名经验丰富的健康顾问提供基线面对面运动咨询，随后在第2、4和6周进行电话咨询，此后每月进行一次，持续一年。每位参与者的初级保健医生对干预措施进行初步认可，随后每月发送针对患者的自动电话信息。个性化进展报告每季度邮寄一次。
评估干预成本。从入组到一年随访期间估计医疗资源使用和成本。计算在主要试验终点实现临床显著变化的增量成本。
每位参与者干预措施的总直接成本为459美元，其中85%是顾问的工作成本。加上管理费用，项目成本总计每位参与者696美元。随访期间，干预组的医疗成本达到10,418美元，而常规护理组为12,052美元（差异=-1,634美元（95%置信区间=-4,683美元至1,416美元；P = 0.29））。以短期临床结果表示，干预措施使每位额外达到目标运动水平的患者成本为4,971美元，或使每位在快速步态速度方面实现临床显著变化的患者成本为4,640美元。
身体活动咨询组在身体活动和快速步态速度方面的改善所花费的成本仅占患者年度医疗保健成本的一小部分。
