Cost-effectiveness of physical activity intervention in children - results based on the Physical Activity and Nutrition in Children (PANIC) study

Virpi Kuvaja-Köllner, Niina Lintu, Virpi Lindi, Elisa Rissanen, Aino-Maija Eloranta, Sanna Kiiskinen, Janne Martikainen, Eila Kankaanpää, Hannu Valtonen, Timo A Lakka, Virpi Kuvaja-Köllner, Niina Lintu, Virpi Lindi, Elisa Rissanen, Aino-Maija Eloranta, Sanna Kiiskinen, Janne Martikainen, Eila Kankaanpää, Hannu Valtonen, Timo A Lakka

Abstract

Background: We assessed the cost-effectiveness of a 2-year physical activity (PA) intervention combining family-based PA counselling and after-school exercise clubs in primary-school children compared to no intervention from an extended service payer's perspective.

Methods: The participants included 506 children (245 girls, 261 boys) allocated to an intervention group (306 children, 60 %) and a control group (200 children, 40 %). The children and their parents in the intervention group had six PA counselling visits, and the children also had the opportunity to participate in after-school exercise clubs. The control group received verbal and written advice on health-improving PA at baseline. A change in total PA over two years was used as the outcome measure. Intervention costs included those related to the family-based PA counselling, the after-school exercise clubs, and the parents' taking time off to travel to and participate in the counselling. The cost-effectiveness analyses were performed using the intention-to-treat principle. The costs per increased PA hour (incremental cost-effectiveness ratio, ICER) were based on net monetary benefit (NMB) regression adjusted for baseline PA and background variables. The results are presented with NMB and cost-effectiveness acceptability curves.

Results: Over two years, total PA increased on average by 108 h in the intervention group (95 % confidence interval [CI] from 95 to 121, p < 0.001) and decreased by 65.5 h (95 % CI from 81.7 to 48.3, p < 0.001) in the control group, the difference being 173.7 h. the incremental effectiveness was 87 (173/2) hours. For two years, the intervention costs were €619 without parents' time use costs and €860 with these costs. The costs per increased PA hour were €6.21 without and €8.62 with these costs. The willingness to pay required for 95 % probability of cost-effectiveness was €14 and €19 with these costs. The sensitivity analyses revealed that the ICER without assuming this linear change in PA were €3.10 and €4.31.

Conclusions: The PA intervention would be cost-effective compared to no intervention among children if the service payer's willingness-to-pay for a 1-hour increase in PA is €8.62 with parents' time costs.

Trial registration: ClinicalTrials.gov: NCT01803776. Registered 4 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=01803776&cntry=&state=&city=&dist= .

Keywords: Children; Cost-effectiveness; Family; Intervention; Multicomponent; Net monetary benefit; Physical activity; School.

Conflict of interest statement

J.M. is a partner of ESiOR Oy, which provides health economic, outcome research, and market access services for pharmaceutical, medical device companies, and hospitals. Other authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Net monetary benefit with parents’ time use costs in relation to willingness to pay for 1-hour increase in PA)
Fig. 2
Fig. 2
Cost-effectiveness acceptability curves for 1-hour increase of PA showing the probability that the intervention is cost-effective compared to the control

References

    1. Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: an update. Canadian journal of applied physiology. 2004;29(1):90–115. doi: 10.1139/h04-008.
    1. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219–229. doi: 10.1016/S0140-6736(12)61031-9.
    1. Hirvensalo M, Lintunen T. Life-course perspective for physical activity and sports participation. European Review of Aging Physical Activity. 2011;8(1):13. doi: 10.1007/s11556-010-0076-3.
    1. Kremers SP, Brug J. Habit strength of physical activity and sedentary behavior among children and adolescents. Pediatr Exerc Sci. 2008;20(1):5–17.
    1. Telama R, Yang X, Viikari J, Valimaki I, Wanne O, Raitakari O. Physical activity from childhood to adulthood: a 21-year tracking study. Am J Prev Med. 2005;28(3):267–73.
    1. Aarts H, Paulussen T, Schaalma H. Physical exercise habit: on the conceptualization and formation of habitual health behaviours. Health Education Research. 1997;12(3):363–374. doi: 10.1093/her/12.3.363.
    1. Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus–present and future perspectives. Nat Rev Endocrinol. 2011;8(4):228–36. doi: 10.1038/nrendo.2011.183.
    1. Messing S, Rutten A, Abu-Omar K, Ungerer-Rohrich U, Goodwin L, Burlacu I, et al. How Can Physical Activity Be Promoted Among Children and Adolescents? A Systematic Review of Reviews Across Settings. Front Public Health. 2019;7:55. doi: 10.3389/fpubh.2019.00055.
    1. van Sluijs EM, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ. 2007;335(7622):703. doi: 10.1136/.
    1. Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJ, Van Sluijs E. Family-based interventions to increase physical activity in children: a systematic review, meta‐analysis and realist synthesis. Obesity reviews. 2016;17(4):345–60. doi: 10.1111/obr.12362.
    1. Harris C, Allen K, Waller C, Brooke V. Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting. BMC Health Serv Res. 2017;17(1):340. doi: 10.1186/s12913-017-2207-2.
    1. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford university press; 2015.
    1. Goodacre S, McCabe C. An introduction to economic evaluation. Emerg Med J. 2002;19(3):198–201. doi: 10.1136/emj.19.3.198.
    1. Lal A, Moodie M, Abbott G, Carver A, Salmon J, Giles-Corti B, et al. The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study. Int J Behav Nutr Phys Act. 2019;16(1):1-8.
    1. Sutherland R, Reeves P, Campbell E, Lubans DR, Morgan PJ, Nathan N, et al. Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the ‘Physical Activity 4 Everyone’ cluster randomized trial. Int J Behav Nutr Phys Act. 2016;13:94.
    1. Callahan LF, Rao J, Boutaugh M. Arthritis and women’s health: prevalence, impact, and prevention. Am J Prev Med. 1996;12(5):401–409. doi: 10.1016/S0749-3797(18)30298-8.
    1. Wu S, Cohen D, Shi Y, Pearson M, Sturm R. Economic analysis of physical activity interventions. Am J Prev Med. 2011;40(2):149–58. doi: 10.1016/j.amepre.2010.10.029.
    1. John J, Wolfenstetter SB, Wenig CM. An economic perspective on childhood obesity: recent findings on cost of illness and cost effectiveness of interventions. Nutrition. 2012;28(9):829–39.
    1. McAuley KA, Taylor RW, Farmer VL, Hansen P, Williams SM, Booker CS, et al. Economic evaluation of a community-based obesity prevention program in children: The APPLE project. Obesity. 2010;18(1):131–6. doi: 10.1038/oby.2009.148.
    1. Vijay SG, Suhrcke M, Atkin AJ, van Sluijs E, Turner D. Cost-effectiveness of physical activity interventions in adolescents: model development and illustration using two exemplar interventions. BMJ Open. 2019;9(8):e027566.
    1. Cradock AL, Barrett JL, Kenney EL, Giles CM, Ward ZJ, Long MW, et al. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Prev Med. 2017;95:S17–27.
    1. Barrett JL, Gortmaker SL, Long MW, Ward ZJ, Resch SC, Moodie ML, et al. Cost Effectiveness of an Elementary School Active Physical Education Policy. Am J Prev Med. 2015;49(1):148–59.
    1. Abu-Omar K, Rutten A, Burlacu I, Schatzlein V, Messing S, Suhrcke M. The cost-effectiveness of physical activity interventions: A systematic review of reviews. Prev Med Rep. 2017;8:72–78. doi: 10.1016/j.pmedr.2017.08.006.
    1. Venalainen TM, Viitasalo AM, Schwab US, Eloranta AM, Haapala EA, Jalkanen HP, et al. Effect of a 2-y dietary and physical activity intervention on plasma fatty acid composition and estimated desaturase and elongase activities in children: the Physical Activity and Nutrition in Children Study. Am J Clin Nutr. 2016;104(4):964–72.
    1. Viitasalo A, Eloranta AM, Lintu N, Vaisto J, Venalainen T, Kiiskinen S, et al. The effects of a 2-year individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet in children. Prev Med. 2016;87:81–88. doi: 10.1016/j.ypmed.2016.02.027.
    1. Lakka TA, Lintu N, Vaisto J, Viitasalo A, Sallinen T, Haapala EA, et al. A 2 year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC study. Diabetologia. 2020;63(11):2270–81.
    1. Haapala EA, Poikkeus AM, Kukkonen-Harjula K, Tompuri T, Lintu N, Vaisto J, et al. Associations of physical activity and sedentary behavior with academic skills–a follow-up study among primary school children. PLoS One. 2014;9(9):e107031.
    1. Vaisto J, Eloranta AM, Viitasalo A, Tompuri T, Lintu N, Karjalainen P, et al. Physical activity and sedentary behaviour in relation to cardiometabolic risk in children: cross-sectional findings from the Physical Activity and Nutrition in Children (PANIC) Study. Int J Behav Nutr Phys Act. 2014;11(1):1-10.
    1. Lintu N. Publications of the University of Eastern Finland Dissertations in Health Sciences Number 395. University of Eastern Finland; Kuopio, 2017. sequence=1&isAllowed=y.
    1. Salary Guide Health Sciences (in Finnish). 2012. .
    1. Official Statistics of Finland (OSF): Labour cost survey [e-publication]. ISSN = 1799–3288. 2012, Appendix Table 2. Structure of labour costs by sector in 2012. Helsinki: Statistics Finland [Internet]. [cited 15.10.2016]. Available from: .
    1. Krol M, Brouwer W. How to estimate productivity costs in economic evaluations. Pharmacoeconomics. 2014;32(4):335–44. doi: 10.1007/s40273-014-0132-3.
    1. Official Statistics of Finland (OSF); Wages, Salaries and Labour costs [Internet]. Official Statistics of Finland (OSF); Wages, Salaries and Labour costs [cited 20.10.2017]. Available from: .
    1. College Station TX. StataCorp LLC. StataCorp. 2017. Stata Statistical Software: Release 15. College Station. TX: StataCorp LLC; 2017.
    1. Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, et al. Good Research Practices for Cost-Effectiveness Analysis Alongside Clinical Trials: The ISPOR RCT-CEA Task Force Report. Value in Health. 2005;8(5):521–33.
    1. Ramsey SD, Willke RJ, Glick H, Reed SD, Augustovski F, Jonsson B, et al. Cost-effectiveness analysis alongside clinical trials II-An ISPOR Good Research Practices Task Force report. Value Health. 2015;18(2):161–72.
    1. Gabrio A, Mason AJ, Baio G. Handling missing data in within-trial cost-effectiveness analysis: a review with future recommendations. PharmacoEconomics-Open. 2017;1(2):79–97. doi: 10.1007/s41669-017-0015-6.
    1. Faria R, Gomes M, Epstein D, White IR. A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. Pharmacoeconomics. 2014;32(12):1157–70. doi: 10.1007/s40273-014-0193-3.
    1. White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30(4):377–399. doi: 10.1002/sim.4067.
    1. Byberg L, Melhus H, Gedeborg R, Sundstrom J, Ahlbom A, Zethelius B, et al. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. Br J Sports Med. 2009;338:b688.
    1. Martikainen S, Pesonen AK, Lahti J, Heinonen K, Feldt K, Pyhala R, et al. Higher levels of physical activity are associated with lower hypothalamic-pituitary-adrenocortical axis reactivity to psychosocial stress in children. J Clin Endocrinol Metab. 2013;98(4):E619-27.
    1. Hoch JS, Rockx MA, Krahn AD. Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of “community acquired” syncope. BMC Health Serv Res. 2006;6:68.
    1. Hoch JS, Dewa CS. Lessons from Trial-Based Cost-Effectiveness Analyses of Mental Health Interventions. Pharmacoeconomics. 2007;25(10):807–16.
    1. Kesztyus D, Schreiber A, Wirt T, Wiedom M, Dreyhaupt J, Brandstetter S, et al. Economic evaluation of URMEL-ICE, a school-based overweight prevention programme comprising metabolism, exercise and lifestyle intervention in children. Eur J Health Econ. 2013;14(2):185–95.
    1. Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ. 2002;11(5):415–30.
    1. Hoch JS, Dewa CS. Advantages of the net benefit regression framework for economic evaluations of interventions in the workplace: a case study of the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. J Occup Environ Med. 2014;56(4):441–5.
    1. Glick HA, Doshi JA, Sonnad SS, Polsky D. Economic evaluation in clinical trials. Second edition ed. OUP Oxford; 2015.
    1. Fimean suositus lääkkeiden hoidollisen ja taloudellisen arvon arvioinnista (in Finnish). Fimean julkaisusarja 2/2012.
    1. Nissinen K. Tilateho-hankkeen loppuraportti N:o1 (in Finnish). Teknologian tutkimuskeskus VTT 2006. .
    1. Laakso T. Production models of swimming hall services in public sector (in Finnish). Faculty of Sport and Health Sciences, University of Jyväskylä, Master’s thesis in Social Sciences of Sport 2017. .
    1. Ainsworth B, Haskell W, Whitt M, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):498–504. doi: 10.1097/00005768-200009001-00009.
    1. Hyewon HL, Levine M. Determining the threshold for acceptability of an ICER when natural health units are used. Journal of Population Therapeutics and Clinical Pharmacology. 2012;19(2):e234-8.
    1. Recommendations for physical activity in early childhood education (in Finnish). Handbooks of the Ministry of Social Affairs and Health, Helsinki 2005 ISSN 1236-116X; 2005:17. .
    1. Lounassalo I, Salin K, Kankaanpää A, Hirvensalo M, Palomäki S, Tolvanen A, et al. Distinct trajectories of physical activity and related factors during the life course in the general population: a systematic review. BMC Public Health. 2019;19(1):1-12.
    1. De Coen V, De Bourdeaudhuij I, Vereecken C, Verbestel V, Haerens L, Huybrechts I, et al. Effects of a 2-year healthy eating and physical activity intervention for 3-6-year-olds in communities of high and low socio-economic status: the POP (Prevention of Overweight among Pre-school and school children) project. Public Health Nutr. 2012;15(9):1737–45.
    1. Ligthart KA, Buitendijk L, Koes BW, van Middelkoop M. The association between ethnicity, socioeconomic status and compliance to pediatric weight-management interventions–a systematic review. Obesity research clinical practice. 2017;11(5):1–51. doi: 10.1016/j.orcp.2016.04.001.
    1. Morning and afternoon activities. Ministry of Education and Culture. Finland. .

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel