Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study
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RESEARCH
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Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study Eelco AB Over1*, GC Wanda Wendel-Vos1, Matthijs van den Berg2, Heleen H Hamberg-van Reenen2, Luqman Tariq1,5, Rudolf T Hoogenveen3 and Pieter HM van Baal4
Abstract Background: Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general practitioner in the Netherlands. Methods: We used the RIVM chronic disease model to estimate the long-term effects of increased physical activity on the future health care costs and quality adjusted life years (QALY) gained, from a health care perspective. Results: The intervention resulted in almost 6000 people shifting to more favorable physical-activity levels, and in 5100 life years and 6100 QALYs gained, at an additional total cost of EUR 67.6 million. The incremental cost-effectiveness ratio (ICER) was EUR 13,200 per life year gained and EUR 11,100 per QALY gained. The intervention has a probability of 0.66 to be cost-effective if a QALY gained is valued at the Dutch informal threshold for cost-effectiveness of preventive intervention of EUR 20,000. A sensitivity analysis showed substantial uncertainty of ICER values. Conclusion: Counseling in combination with pedometer use aiming to increase physical activity may be a cost-effective intervention. However, the intervention only yields relatively small health benefits in the Netherlands. Keywords: Economic evaluation, Prevention, Modeling, Counseling, Pedometer use, Physical activity, Primary care
Background Lack of physical activity increases the risk of numerous adverse health conditions, including coronary artery disease, hypertension, stroke, insulin sensitivity, osteoporosis, and cancer [1]. In the Netherlands, it has been estimated that about 6% of total mortality can be attributed to physical inactivity [2]. In 2007, about 44% of the Dutch population aged 12 or above did not meet the recommendation to accumulate at least 30 minutes of moderate-intensity physical activity on at least five days of the week, and were classified as physically inactive (17%) or insufficiently active (27%) [3]. Therefore,
* Correspondence: [email protected] 1 Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands Full list of author information is available at the end of the article
increasing physical activity has the potential to reduce the burden of disease in the Netherlands considerably. Recently, pedometers have become a popular tool for motivating people to engage in physical activity [4,5]. Pedometers are small, relatively inexpensive, devices worn at the hip to count the number of steps walked per day. Together with a calendar, diary, or daily log to keep record of and reflect on th
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