Brief advice about physical activity is cost effective

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Brief advice is a cost-effective way for primary care doctors to advise their patients about physical activity, new research from the UK suggests.

Brief verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up, is a cost-effective way to improve physical activity among adults, has short-term mental health benefits and can take place in a few seconds or minutes, the authors wrote in a paper online December 18 in the British Journal of Sports Medicine.

"Primary care has a huge potential for helping adults increase their activity because people generally trust healthcare professionals as a source of health-related advice," wrote Dr. Emmanuel Stamatakis of the Department of Epidemiology and Public Health of University College London, UK, in an email to Reuters Health.

"Brief physical activity intervention should become the norm. It should not be one-off and opportunistic but systematic and repeated over long periods of time," wrote Dr. Stamatakis, who was not involved in the study.

To investigate whether brief advice in primary care is a cost-effective way to promote physical activity, Dr. Nana K. Anokye of the Health Economics Research Group of Brunel University in London, UK, and colleagues compared the lifetime costs and outcomes of 100,000 people exposed to brief advice versus usual care.

They took their data from systematic literature reviews and literature searches of economic evaluations conducted for national guidelines, and they looked for reduced risk for coronary heart disease, stroke and type 2 diabetes.

To reflect the average age of participants in the trials of BA, they followed the inactive but healthy adults starting at 33 years of age through their remaining lifetime using a Markov model, and they estimated the results for cohorts of different ages by sensitivity analysis. Patients in the intervention group received brief physical activity advice while those in the control group received usual care but no active intervention.

Physical activity involved at least 150 minutes of moderate or more intensive physical activity, or at least 75 minutes of vigorous PA, per week. Health outcomes were expressed in quality-adjusted life years (QALYs) and costs to health providers were based on 2010 and 2011 prices.

They estimated that 6,994 additional people would become active at the end of year one year, costing £950,000, or about US$1,564,000, which came out to (£136 or US$224 for each additionally active person.

Brief advice also would avert an estimated 2.4 coronary heart disease cases, 1.8 strokes, 3.1 diabetes events, and 1 death in 10 years.

Compared with usual care, brief advice is £806,809 (US$1,328,250) more costly, but it's also more effective with a QALY gain of 0.0047/person.

At a threshold of £5,000 (US $8,232) per QALY, the estimated probability that brief advice is cost-effective is 0.91. At £20,000 (US$32,926) it rises to 0.99. The cost-effectiveness increases with older patients.

"This study had robust methodology and showed some very encouraging findings in terms of the cost effectiveness of such interventions," Dr. Stamatakis wrote.

He advised educating physicians on how to assist their patients to change physical activity behavior and urged greater support from the broader healthcare system.

"We are rating terribly in the research investment on how to change perhaps the most important human behavior," he wrote.

"A health professional with a 50-year-old patient has to intervene and change 35 or 45 years of deeply rooted inactivity habits. Unless this brief advice is systematic, repeated, and supported by a broader preventative healthcare system, it will be very difficult to get long-term results or any results at all. It is rather naive to expect a three or five minute consultation to change these habits that patients are forming over such a long period of time," he wrote.

"Research should identify the best ways healthcare professionals can empower people from all age groups and socioeconomic and cultural backgrounds to be active and physicians should have multiple opportunities to be trained during medical school and in continuing medical education on how to deliver these interventions," he wrote.

The authors called for further research to explore the factors contributing to the cost-effectiveness of BA on PA.

The authors did not reply to requests for comments.

SOURCE: http://bit.ly/1cXl2W2

Br J Sports Med 2013.

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