Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial

Jennifer C Davis, Ging-Yuek Robin Hsiung, Stirling Bryan, John R Best, Janice J Eng, Michelle Munkacsy, Winnie Cheung, Bryan Chiu, Claudia Jacova, Philip Lee, Teresa Liu-Ambrose, Jennifer C Davis, Ging-Yuek Robin Hsiung, Stirling Bryan, John R Best, Janice J Eng, Michelle Munkacsy, Winnie Cheung, Bryan Chiu, Claudia Jacova, Philip Lee, Teresa Liu-Ambrose

Abstract

Background/objectives: Evidence suggests that aerobic exercise may slow the progression of subcortical ischaemic vascular cognitive impairment (SIVCI) by modifying cardiovascular risk factors. Yet the economic consequences relating to aerobic training (AT) remain unknown. Therefore, our primary objective was to estimate the incremental cost per quality-adjusted life years (QALYs) gained of a thrice weekly AT intervention compared with usual care.

Design: Cost-utility analysis alongside a randomised trial.

Setting: Vancouver, British Columbia, Canada.

Participants: 70 adults (mean age of 74 years, 51% women) who meet the diagnostic criteria for mild SIVCI.

Intervention: A 6-month, thrice weekly, progressive aerobic exercise training programme compared with usual care (CON; comparator) with a follow-up assessment 6 months after formal cessation of aerobic exercise training.

Measurements: Healthcare resource usage was estimated over the 6-month intervention and 6-month follow-up period. Health status (using the EQ-5D-3L) at baseline and trial completion and 6-month follow-up was used to calculate QALYs. The incremental cost-utility ratio (cost per QALY gained) was calculated.

Results: QALYs were both modestly greater, indicating a health gain. Total healthcare costs (ie, 1791±1369 {2015 $CAD} at 6 months) were greater, indicating a greater cost for the thrice weekly AT group compared with CON. From the Canadian healthcare system perspective, the incremental cost-utility ratios for thrice weekly AT were cost-effective compared with CON, when using a willingness to pay threshold of $CAD 20 000 per QALY gained or higher.

Conclusions: AT represents an attractive and potentially cost-effective strategy for older adults with mild SIVCI.

Trial registration number: NCT01027858.

Keywords: aerobic training; cost-utility analysis; economic evaluation; exercise; mild cognitive impairment; older adults.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
(A) Cost-effective plane (time horizon—6 months) depicting the 95% confidence ellipses of incremental cost and effectiveness (patient-rated health status) for comparison between thrice weekly aerobic training and usual care (control, comparator). (B) Cost-effective plane (time horizon—6 months) depicting the 95% confidence ellipses of incremental cost and effectiveness (caregiver (patient-proxy) rated health status) for comparison between thrice weekly aerobic training and usual care (control, comparator). (C) Cost-effective plane (time horizon—12 months) depicting the 95% confidence ellipses of incremental cost and effectiveness (patient-rated health status) for comparison between thrice weekly aerobic training and usual care (control, comparator). (D) Cost-effective plane (time horizon—12 months) depicting the 95% confidence ellipses of incremental cost and effectiveness (caregiver (patient-proxy) rated health status) for comparison between thrice weekly aerobic training and usual care (control, comparator).
Figure 2
Figure 2
(A) Cost-effectiveness acceptability curve showing the probability that thrice aerobic training intervention is cost-effective compared to usual care over a range of values for the maximum acceptable ceiling ratio (λ—willingness to pay) in the PROMoTE trial (6-month time horizon, patient-rated health status). (B) Cost-effectiveness acceptability curve showing the probability that thrice aerobic training intervention is cost-effective compared to usual care over a range of values for the maximum acceptable ceiling ratio (λ—willingness to pay) in the PROMoTE trial (6-month time horizon, caregiver (patient-proxy)-rated health status). (C) Cost-effectiveness acceptability curve showing the probability that thrice aerobic training intervention is cost-effective compared to usual care over a range of values for the maximum acceptable ceiling ratio (λ—willingness to pay) in the PROMoTE trial (12-month time horizon, patient-rated health status). (D) Cost-effectiveness acceptability curve showing the probability that thrice aerobic training intervention is cost-effective compared to usual care over a range of values for the maximum acceptable ceiling ratio (λ—willingness to pay) in the PROMoTE trial (12-month time horizon, caregiver (patient-proxy) rated health status).

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