Cost Effectiveness of Community-Based Physical Activity Interventions

Background

Physical inactivity is associated with the increased risk of many chronic diseases. Such risks decrease with increases in physical activity. This study assessed the cost-effectiveness of population-wide strategies to promote physical activity in adults and followed disease incidence over a lifetime.

Methods

A lifetime cost-effectiveness analysis from a societal perspective was conducted to estimate the costs, health gains, and cost-effectiveness (dollars per quality-adjusted life year [QALY] gained, relative to no intervention) of seven public health interventions to promote physical activity in a simulated cohort of healthy U.S. adults stratified by age, gender, and physical activity level. Interventions exemplifying each of four strategies strongly recommended by the Task Force on Community Preventive Services were evaluated: community-wide campaigns, individually adapted health behavior change, community social-support interventions, and the creation of or enhanced access to physical activity information and opportunities. Each intervention was compared to a no-intervention alternative. A systematic review of disease burden by physical activity status was used to assess the relative risk of five diseases (coronary heart disease, ischemic stroke, type 2 diabetes, breast cancer, and colorectal cancer) across a spectrum of physical activity levels. Other data were obtained from clinical trials, population-based surveys, and other published literature.

Results

Cost-effectiveness ratios ranged between $14,000 and $69,000 per QALY gained, relative to no intervention. Results were sensitive to intervention-related costs and effect size.

Conclusions

All of the evaluated physical activity interventions appeared to reduce disease incidence, to be cost-effective, and—compared with other well-accepted preventive strategies—to offer good value for money. The results support using any of the seven evaluated interventions as part of public health efforts to promote physical activity.

a Physical Activity and Health Branch, Division of Nutrition, Physical Activity and Obesity, CDC, Atlanta, Georgia

b Chronic Disease, Injury, and Environmental Epidemiology Section, Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia

c Milliman, Denver, Colorado

d Stryker Instruments Manufacturing, Freiburg, Germany

e Prevention Research Center, School of Public Health, St. Louis University, St. Louis, Missouri

f University of Tennessee College, Chattanooga, Tennessee

g Outcomes Research and Management, Merck & Co., Inc., West Point, Virginia

h Department of Policy Analysis and Management, Cornell University, Ithaca, New York

i Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts

Address correspondence and reprint requests to: Larissa Roux, MD, MPH, PhD, 5612 Elm Street, Vancouver BC, Canada V6N-1A4

The full text of this article is available via AJPM Online at www.ajpm-online.net.

PII: S0749-3797(08)00770-8

doi:10.1016/j.amepre.2008.06.040

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