[ARTICLE] Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial – Full Text

Abstract

Question

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program?

Design

A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon.

Participants

People with chronic health conditions who had completed a 6-week exercise program at a community health service.

Interventions

One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks.

Outcome measures

Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L).

Results

Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1 year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach.

Conclusion

The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently.

Introduction

Chronic conditions that are related to physical inactivity, such as coronary heart disease, type II diabetes and stroke, are estimated to result in direct healthcare costs of over AUD377 million per year in Australia.1 ;  2 Implementing strategies to increase physical activity in adults with chronic health conditions may be an effective way of reducing the economic impact in Australia. Short-term (ie, 4 to 6 week) supervised interventions, such as cardiac and pulmonary phase II rehabilitation programs, have been shown to be effective in improving quality of life and reducing morbidity and healthcare costs.3 ;  4However, there is evidence to suggest that once the program is completed, adherence to exercise declines along with the health benefits obtained.5 Hence, there is a need to provide interventions to promote long-term exercise adherence after the completion of a short-term exercise program.

A recent review of this field identified two commonly investigated approaches to improve ongoing exercise adherence for adults with chronic health conditions: home-based exercise programs with telephone follow-up, and gym-based exercise programs.6 That review and meta-analysis found no difference in exercise adherence rates between these interventions. Furthermore, it identified no economic evaluations examining the comparative efficiency of the two approaches.

There is an ongoing need to identify efficient means of promoting adherence to exercise in the long term, in order to improve the quality of life of adults with chronic health conditions. The aim of the current study was to examine the economic efficiency of home-based maintenance with telephone follow-up compared with gym-based maintenance exercise amongst adults with a variety of chronic conditions who had completed a short-term supervised exercise program led by a health professional.

Therefore, the study question for this economic analysis of that randomised trial was:

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program?

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