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Physical Activity Interventions for Primary Prevention in Adults: A Systematic Review of Randomized Controlled Trial-Based Economic Evaluations

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Abstract

Background

Physical inactivity is a worldwide pandemic associated with major chronic diseases. Given limited resources, policy makers are in need of physical activity interventions that provide best value for money.

Objective

To summarize evidence from RCT-based economic evaluations of primary prevention physical activity interventions in adult populations outside the workplace setting.

Design

Systematic review of health economic evaluations. Incremental cost-effectiveness ratios (ICERs) in US$ per MET-hour gained were estimated on the basis of mean differences in intervention costs and standardized effects between intervention and control groups.

Data Sources

Identification of relevant studies via systematic searches in electronic databases (MEDLINE, Embase and NHSEED).

Eligibility Criteria

Cost-effectiveness analyses in which all data (except unit costs) came from one RCT investigating physical activity interventions for primary prevention or health promotion in an adult population in high-income countries.

Results

In twelve eligible studies, 22 interventions were investigated. Interventions were based on advice, goal setting and follow-up support, exercise classes, financial incentives or teaching on behavioral change. The ICER varied widely among the interventions and four interventions showed an ICER below the applied benchmark of US$0.44 to US$0.63 per MET-hour gained. These four interventions were based on individualized advice via print or web.

Conclusion

We found evidence from RCTs indicating cost-effectiveness of some physical activity interventions for primary prevention in adults. However, the majority of interventions assessed would not be cost-effective according to the benchmark applied. Furthermore, our study showed that trial-based evidence on cost-effectiveness of physical activity interventions is scarce. Therefore, we recommend that future studies investigating the efficacy or effectiveness of such interventions consider costs as an additional outcome and assess cost-effectiveness.

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Data Availability

Any additional information (e.g., review protocol) is available upon request from the corresponding author.

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Authors and Affiliations

  1. Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland

    Renato Mattli & Matthias Schwenkglenks

  2. Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland

    Renato Mattli, Renato Farcher, Maria-Eleni Syleouni & Simon Wieser

  3. Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland

    Nicole Probst-Hensch

  4. University of Basel, Petersplatz 1, 4001, Basel, Switzerland

    Nicole Probst-Hensch

  5. Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Mittlere Allee 18, 4052, Basel, Switzerland

    Arno Schmidt-Trucksäss

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  1. Renato Mattli
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Contributions

RM and MS conceived the design of the study; RM and RF screened the studies; RM and MES extracted the data; RM, MES, SW, AST, MS were involved in the data analysis; RM drafted the manuscript. All authors were involved in the interpretation of the data and commented on and edited the final manuscript.

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Correspondence to Renato Mattli.

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Renato Mattli, Renato Farcher, Maria-Eleni Syleouni, Simon Wieser, Nicole Probst-Hensch, Arno Schmidt-Trucksäss and Matthias Schwenkglenks declare that they have no conflicts of interest relevant to the content of this review.

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Mattli, R., Farcher, R., Syleouni, ME. et al. Physical Activity Interventions for Primary Prevention in Adults: A Systematic Review of Randomized Controlled Trial-Based Economic Evaluations. Sports Med 50, 731–750 (2020). https://doi.org/10.1007/s40279-019-01233-3

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