Rotman School of Management, University of Toronto, Toronto, ON, Canada.
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
BMC Public Health. 2021 Oct 27;21(1):1950. doi: 10.1186/s12889-021-11988-y.
Government interest in investing in commercial physical activity apps has increased with little evidence of their cost-effectiveness. This is the first study to our knowledge to examine the cost-effectiveness of a commercial physical activity app (Carrot Rewards) despite there being over 100,000 in the major app stores.
A cost-effectiveness analysis was performed to calculate the incremental cost-effectiveness ratio (ICER) of the app compared to a no-intervention reference scenario using a five-year time horizon. Primary data was collected between 2016 and 2017. Data synthesis, model creation, and statistical analyses were conducted between 2019 and 2020. An age-, sex-, and geography-dependent Markov model was developed assuming a public healthcare payer perspective. A closed cohort (n = 38,452) representing the population reached by Carrot Rewards in two Canadian provinces (British Columbia, Newfoundland & Labrador) at the time of a 12-month prospective study was used. Costs and effects were both discounted at 1.5% and expressed in 2015 Canadian dollars. Subgroup analyses were conducted to compare ICERs between provinces, sexes, age groups, and engagement levels.
Carrot Rewards had an ICER of $11,113 CAD per quality adjusted life year (QALY), well below a $50,000 CAD per QALY willingness-to-pay (WTP) threshold. Subgroup analyses revealed that the app had lower ICERs for British Columbians, females, highly engaged users, and adults aged 35-64 yrs., and was dominant for older adults (65 + yrs). Deterministic sensitivity analyses revealed that the ICER was most influenced by the relative risk of diabetes. Probabilistic sensitivity analyses revealed varying parameter estimates predominantly resulted in ICERs below the WTP threshold.
The Carrot Rewards app was cost-effective, and dominant for older adults. These results provide, for the first time, rigorous health economic evidence for a commercial physical activity app as part of public health programming.
政府对投资商业性体力活动应用程序的兴趣有所增加，但几乎没有证据表明其具有成本效益。这是我们所知的首次研究，旨在检查一款商业性体力活动应用程序（Carrot Rewards）的成本效益，尽管主要应用程序商店中已有超过 100,000 款此类应用程序。
使用五年时间范围，进行成本效益分析，以计算该应用程序相对于无干预参考情景的增量成本效益比（ICER）。主要数据于 2016 年至 2017 年收集。数据综合、模型创建和统计分析于 2019 年至 2020 年进行。从公共医疗保健支付者的角度出发，开发了一个基于年龄、性别和地理位置的马尔可夫模型。使用了一项为期 12 个月的前瞻性研究期间，在加拿大两个省份（不列颠哥伦比亚省、纽芬兰与拉布拉多省）可接触到 Carrot Rewards 的人群的封闭队列（n=38,452）。成本和效果均以 1.5%贴现，以 2015 年加拿大元表示。进行了亚组分析，以比较各省、性别、年龄组和参与度之间的 ICER。
Carrot Rewards 的每质量调整生命年（QALY）成本效益比为 11,113 加元，远低于 50,000 加元/QALY 的支付意愿（WTP）阈值。亚组分析显示，该应用程序在不列颠哥伦比亚省、女性、高度活跃的用户和 35-64 岁的成年人中的 ICER 较低，在 65 岁及以上的老年人中具有优势。确定性敏感性分析表明，ICER 受糖尿病相对风险的影响最大。概率敏感性分析表明，参数估计的变化主要导致 ICER 低于 WTP 阈值。
Carrot Rewards 应用程序具有成本效益，并且对老年人具有优势。这些结果首次提供了有关商业性体力活动应用程序作为公共卫生计划一部分的严格健康经济学证据。
