Anokye Nana, Fox-Rushby Julia, Sanghera Sabina, Cook Derek G, Limb Elizabeth, Furness Cheryl, Kerry Sally Margaret, Victor Christina R, Iliffe Steve, Ussher Michael, Whincup Peter H, Ekelund Ulf, deWilde Stephen, Harris Tess
Health Economics Research Group, Brunel University, London, UK.
Department of Population Health Sciences, Guy's Campus, King's College London, London, UK.
BMJ Open. 2018 Oct 17;8(10):e021978. doi: 10.1136/bmjopen-2018-021978.
A short-term and long-term cost-effectiveness analysis (CEA) of two pedometer-based walking interventions compared with usual care.
(A) Short-term CEA: parallel three-arm cluster randomised trial randomised by household. (B) Long-term CEA: Markov decision model.
Seven primary care practices in South London, UK.
(A) Short-term CEA: 1023 people (922 households) aged 45-75 years without physical activity (PA) contraindications. (b) Long-term CEA: a cohort of 100 000 people aged 59-88 years.
Pedometers, 12-week walking programmes and PA diaries delivered by post or through three PA consultations with practice nurses.
Accelerometer-measured change (baseline to 12 months) in average daily step count and time in 10 min bouts of moderate to vigorous PA (MVPA), and EQ-5D-5L quality-adjusted life-years (QALY).
Resource use costs (£2013/2014) from a National Health Service perspective, presented as incremental cost-effectiveness ratios for each outcome over a 1-year and lifetime horizon, with cost-effectiveness acceptability curves and willingness to pay per QALY. Deterministic and probabilistic sensitivity analyses evaluate uncertainty.
(A) Short-term CEA: At 12 months, incremental cost was £3.61 (£109)/min in ≥10 min MVPA bouts for nurse support compared with control (postal group). At £20 000/QALY, the postal group had a 50% chance of being cost saving compared with control. (B) Long-term CEA: The postal group had more QALYs (+759 QALYs, 95% CI 400 to 1247) and lower costs (-£11 million, 95% CI -12 to -10) than control and nurse groups, resulting in an incremental net monetary benefit of £26 million per 100 000 population. Results were sensitive to reporting serious adverse events, excluding health service use, and including all participant costs.
Postal delivery of a pedometer intervention in primary care is cost-effective long term and has a 50% chance of being cost-effective, through resource savings, within 1 year. Further research should ascertain maintenance of the higher levels of PA, and its impact on quality of life and health service use.
ISRCTN98538934; Pre-results.
对两种基于计步器的步行干预措施与常规护理进行短期和长期成本效益分析（CEA）。
（A）短期CEA：按家庭随机分组的平行三臂整群随机试验。（B）长期CEA：马尔可夫决策模型。
英国伦敦南部的7家初级保健机构。
（A）短期CEA：1023人（922户家庭），年龄在45 - 75岁之间，无身体活动（PA）禁忌证。（B）长期CEA：100000名年龄在59 - 88岁之间的队列人群。
计步器、为期12周的步行计划以及通过邮寄或与执业护士进行三次PA咨询提供的PA日记。
通过加速度计测量的平均每日步数变化（基线至12个月）以及10分钟中度至剧烈PA（MVPA）的时间，以及EQ - 5D - 5L质量调整生命年（QALY）。
从英国国家医疗服务体系的角度计算资源使用成本（2013/2014英镑），以1年和终身时间范围内每个结局的增量成本效益比表示，并绘制成本效益可接受性曲线以及每QALY的支付意愿。确定性和概率性敏感性分析评估不确定性。
（A）短期CEA：在12个月时，与对照组（邮寄组）相比，护士支持组在≥10分钟MVPA时段的增量成本为每分钟3.61英镑（109英镑）。在每QALY 20000英镑的情况下，邮寄组与对照组相比有50%的成本节约可能性。（B）长期CEA：邮寄组比对照组和护士组有更多的QALY（多759个QALY，95%CI 400至1247）且成本更低（少1100万英镑，95%CI - 12至 - 10），导致每100000人口的增量净货币效益为2600万英镑。结果对报告严重不良事件、排除医疗服务使用以及纳入所有参与者成本较为敏感。
在初级保健中通过邮寄方式提供计步器干预措施长期来看具有成本效益，并且在1年内有50%的可能性通过资源节约实现成本效益。进一步的研究应确定较高水平PA的维持情况及其对生活质量和医疗服务使用的影响。
ISRCTN98538934；预结果。
