Does age modify the cost-effectiveness of community-based physical activity interventions?

BACKGROUND: Community-based efforts to promote physical activity (PA) in adults have been found to be cost-effective in general, but it is unknown if this is true in middle-age specifically. Age group-specific economic evaluations could help inform the design and delivery of better and more tailored PA promotion. METHODS: A Markov model was developed to estimate the cost-effectiveness (CE) of 7 exemplar community-level interventions to promote PA recommended by the Guide to Community Preventive Services, over a 20-year horizon. The CE of these interventions in 25- to 64-year-old adults was compared with their CE in middle-aged adults, aged 50 to 64 years. The robustness of the results was examined through sensitivity analyses. RESULTS: Cost/QALY (quality-adjusted life year) of the evaluated interventions in 25- to 64-year-olds ranged from $42,456/QALY to $145,868/QALY. Interventions were more cost-effective in middle-aged adults, with CE ratios 38% to 47% lower than in 25- to 64-year-old adults. Sensitivity analyses showed greater than a 90% probability that the true CE of 4 of the 7 interventions was below $125,000/QALY in adults aged 50 to 64 years. CONCLUSION: The exemplar PA promotion interventions evaluated appeared to be especially cost-effective for middle-aged adults. Prioritizing such efforts to this age group is a good use of societal resources.

2014 consensus statement from the first Economics of Physical Inactivity Consensus (EPIC) conference (Vancouver).

This article describes major topics discussed from the 'Economics of Physical Inactivity Consensus Workshop' (EPIC), held in Vancouver, Canada, in April 2011. Specifically, we (1) detail existing evidence on effective physical inactivity prevention strategies; (2) introduce economic evaluation and its role in health policy decisions; (3) discuss key challenges in establishing and building health economic evaluation evidence (including accurate and reliable costs and clinical outcome measurement) and (4) provide insight into interpretation of economic evaluations in this critically important field. We found that most methodological challenges are related to (1) accurately and objectively valuing outcomes; (2) determining meaningful clinically important differences in objective measures of physical inactivity; (3) estimating investment and disinvestment costs and (4) addressing barriers to implementation. We propose that guidelines specific for economic evaluations of physical inactivity intervention studies are developed to ensure that related costs and effects are robustly, consistently and accurately measured. This will also facilitate comparisons among future economic evidence.

Physical activity, cardiovascular disease, and medical expenditures in U.S. adults.

BACKGROUND: Physical inactivity is an established independent risk factor for cardiovascular disease (CVD), the leading cause of death and disability among U.S. adults. Information on the economic impact of CVD associated with inactivity is lacking, however, although it is needed to attract more resources for preventing CVD and promoting physical activity. PURPOSE: The objective of this study was to estimate the direct medical expenditures of CVD associated with inactivity. METHODS: A population-based analysis of direct medical expenditure was performed by linking the 1996 Medical Expenditure Panel Survey to the 1995 National Health Interview Survey. The study participants were adults (N = 2,472; ages > or = 19 years; not pregnant) in the noninstitutionalized, civilian population in 1996. Medical expenditures associated with inactivity were derived by comparing the medical expenditures between population groups stratified by physical activity and CVD status. RESULTS: In 1996, the prevalence of physical inactivity was 47.5%. The overall prevalence of CVD was 21.5% (16.7% in active persons, 23.6% in inactive persons, and 49.5% in persons with physical limitations). In this population, there were 7.3 million CVD cases. 1.1 million of them (15.3%) were associated with inactivity. The total medical expenditure of persons with CVD was US 41.3 billion dollars, of which US 5.4 billion dollars (13.1%) was associated with inactivity. Applying these percentages to the total health and economic burdens of CVD in the United States, there were 9.2 million CVD cases (US 23 .7 billion dollars direct medical expenditure) associated with inactivity in 2001. CONCLUSIONS: The high economic burden of inactivity-associated CVD demonstrates the need to promote physical activity among U.S. adults.

Economic burden of cardiovascular disease associated with excess body weight in U.S. adults.

BACKGROUND: Excess body weight (EBW), which continues to become more prevalent, is a clear contributor to cardiovascular disease (CVD), the leading cause of death and disability among U.S. adults. Information on the economic impact of CVD associated with EBW is lacking, however. OBJECTIVE: To estimate the direct medical costs of CVD associated with EBW. METHODS: We conducted a population-based analysis of direct medical costs by linking the 1995 National Health Interview Survey and the 1996 Medical Expenditure Panel Survey. The study subjects are adults (aged > or =25 years, excluding pregnant women) in the non-institutionalized, civilian population in 1996. RESULTS: The prevalence of CVD among people in the normal weight (body mass index [BMI] > or =18.5 to <25), overweight (BMI > or =25 to <30), and obese (BMI > or =30) groups was 20%, 28%, and 39%, respectively. There were 12.95 million CVD cases among overweight people, more than 25% of which was associated with overweight. There were 9.3 million CVD cases among obese people, of which more than 45% was associated with obesity. This extra disease burden led to $22.17 billion in direct medical costs in 1996 ($31 billion in 2001 dollars, 17% of the total direct medical cost of treating CVD). CONCLUSIONS: The strong positive association between EBW and CVD, and the significant economic impact of EBW-associated CVD demonstrate the need to prevent EBW among U.S. adults.