Five-year cost-effectiveness analysis of the European Fans in Training (EuroFIT) physical activity intervention for men versus no intervention
Creators
- Kolovos, Spyros1
- Finch, Aureliano P.1
- van der Ploeg, Hidde P.2
- van Nassau, Femke2
- Broulikova, Hana M.1
- Baka, Agni1
- Treweek, Shaun3
- Gray, Cindy M.4
- Jelsma, Judith G. M.2
- Bunn, Christopher4
- Roberts, Glyn C.5
- Silva, Marlene N.6
- Gill, Jason M. R.7
- Røynesdal, Øystein5
- van Mechelen, Willem2
- Andersen, Eivind5
- Hunt, Kate8
- Wyke, Sally4
- Bosmans, Judith E.1
- 1. Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- 2. Amsterdam UMC, VU medical center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
- 3. Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- 4. Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
- 5. Department of coaching and psychology, Norwegian School of Sport Science, Oslo, Norway
- 6. CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- 7. Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- 8. Institute for Social Marketing and Health, University of Stirling, Stirling, UK
Description
Objectives: Increasing physical activity reduces the risk of chronic illness including Type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle interventions can increase physical activity but few successfully engage men. This study aims to investigate the 5 year cost-effectiveness of EuroFIT, a program to improve physical activity tailored specifically for male football (soccer) fans compared to a no intervention comparison group.
Methods: We developed a Markov cohort model in which the impact of improving physical activity on five chronic health conditions (colorectal cancer, Type 2 diabetes, coronary heart disease, stroke and depression) and mortality was modelled. We estimated costs from a societal perspective and expressed benefits as quality adjusted life years (QALYs). We obtained data from a 4-country (England, Netherlands, Portugal and Norway) pragmatic randomised controlled trial evaluating EuroFIT, epidemiological and cohort studies, and meta-analyses. We performed deterministic and probabilistic sensitivity analyses to assess the impact of uncertainty in the model's parameter values on the cost-effectiveness results. We used Monte Carlo simulations to estimate uncertainty and presented this using cost-effectiveness acceptability curves (CEACs). We tested the robustness of the base case analysis using five scenario analyses.
Results: Average costs over 5 years per person receiving EuroFIT were €14,663 and per person receiving no intervention €14,598. Mean QALYs over 5 years were 4.05 per person for EuroFIT and 4.04 for no intervention. Thus, the average incremental cost per person receiving EuroFIT was €65 compared to no intervention, while the average QALY gain was 0.01. This resulted in an ICER of €5206 per QALY gained. CEACs show that the probability of EuroFIT being cost-effective compared to no intervention is 0.53, 0.56 and 0.58 at thresholds of €10,000, €22,000 and €34,000 per QALY gained, respectively. When using a time horizon of 10 years, the results suggest that EuroFIT is more effective and less expensive compared to (i.e. dominant over) no intervention with a probability of cost-effectiveness of 0.63 at a threshold of €22,000 per QALY gained.
Conclusions: We conclude the EuroFIT intervention is not cost-effective compared to no intervention over a period of 5 years from a societal perspective, but is more effective and less expensive (i.e. dominant) after 10 years. We thus suggest that EuroFIT can potentially improve public health in a cost-effective manner in the long term.