Characteristics of included studies
| Study, setting, quality | Objective; economic perspective, cost year | Study type; economic analysis type | Interventions compared | Participants | Follow-up duration | Definition of physically active person | Mean time to deliver intervention per person | Outcome | |
|---|---|---|---|---|---|---|---|---|---|
| Cost of converting to an ‘active category’ (£ at the time of the study) (£ inflated to 2011) | ICER (£ at the time of the study) (£ inflated to 2011) | ||||||||
| Anokye et al,35 UK, good | Brief exercise advice in primary care; healthcare (NHS), 2010/2011 | Economic modelling; CUA | I: brief advice C: usual care (no active intervention) | Cohort of 100 000 physically inactive but healthy adults aged ≥33 years | Modelled for lifetime | 150 min of MPA or 75 min of VPA per week | Not mentioned | £136 (brief advice compared with usual care) | £1730/QALY gained |
| Boehler et al,36 UK, fair | PA promotion in primary care; health service (NHS), 2007 | PA care pathway pilot-based regression model; CEA | Brief exercise comparing 2 recruitment strategies: I1: patients recruited opportunistically I2: patients on the hypertension disease register ‘disease register sites’ | Insufficiently active, 16–74 years | 3 months | 150 min of MPA per week | I1: 4 min I2: 18 min Total across intervention: I1: 28 min I2: 76 min | £886.50 (£986) disease register vs opportunistic recruitment | |
| Cobiac et al,44 Australia, high | PA promotion in community; health sector, 2003 | Economic modelling study; CUA | I1: GP prescription—exercise prescription with follow-up phone call I2: GP referral for PA counselling to an exercise physiologist I3: mass media I4: TravelSmart (active transport) I5: pedometer I6: internet advice C: do nothing | I1: 40–79 years old less active patients I2: 60+ years sedentary I3: 25–60 years 14: 18+ years I5: 15+ years I6: 15+ years | Modelled for lifetime | 150 min of moderate intensity of 5 METs per week | Not mentioned | I1: $A11 000 (£5374) (£6500) per DALY I2: $A75 000 (£36 638) (£44 315 ) per DALY I3: dominant I4: $A 18 000 (£8793) (£10 636 ) per DALY I5: dominant I6: $A2000 (£977) (£1182) per DALY when compared with ‘do nothing’ | |
| Dalziel et al,40 New Zealand, high | Primary care-based exercise counselling/prescription; health system, 2001 | RCT-based economic modelling; CUA | I: green prescription C: usual care (no additional exercise advice) | Less active participants; 40–79 years I: 451 C: 427 | Modelled over full life expectancy | 5×30 min of MPA or VPA per week | 7 min (GP); 13 min (practice nurse) | NZD 2053 (£865) (£1104) per QALY (lifetime) | |
| Elley et al,42 New Zealand, high | Primary care exercise counselling/prescription; health funder's and societal, 2001 | RCT; CEA | I: green prescription (brief oral or written advice) by a GP or practice nurse with telephone exercise specialist follow-up C: usual care (do nothing) | 40–79 years old less active patients in general practice I: 451 C: 427 | 12 months | 150 min/week | 7 min (GP); 13 min (nurse) | NZD 1756 (£740) (£938) | |
| Elley et al,41 New Zealand, high | Primary care exercise counselling/prescription with ongoing support; Societal, 2008 | RCT; CEA | I: enhanced green prescription (nurse-delivered brief advice and a written exercise prescription, counselling in primary care with telephone follow-up) C: usual care (do nothing) | Physically inactive women aged 40–74 years I: 544 C: 545 | 24 months | 150 min/week of at least MPA | 10 min brief advice and a written prescription | NZD 687 (£285) (£308) sustained at 12 months; NZD 1407 (£584) (£630) sustained at 24 months | |
| Gulliford et al,37 UK, good | Universal strategy to promote PA in primary care; healthcare service, 2010 | Economic modelling; CUA | I: brief GP advice in primary care C: standard care (do nothing) | 262 704 healthy participants aged 30–100 years from GPRD | Modelled for lifetime | 150 min of moderate PA per week | Not mentioned | Net health benefit of 3.2 QALYs per 1000 participants (at a threshold of £30 000/QALY); £13 686 (£14 002)/QALY | |
| Leung et al,43 New Zealand, High | Pedometer-based exercise advice to increase PA; societal, 2008 | RCT; CUA | I1: pedometer-based green prescription I2: standard green prescription (exercise advice & time-related goal) | Healthy inactive adults aged ≥65 years I1: 165 I2: 165 | 12 months | 150 min of at least MPA per week | Not mentioned | $A667 (£290) (£313) | |
| Lindgren et al,46 Sweden, good | Dietary and exercise advice; societal and payer's, 2000 | RCT-based economic modelling; CEA | I1: dietary advice by dieticians I2: exercise advice by a physician I3: exercise & diet C: usual care (no intervention) | Men aged 35–60 years I1: 40 I2: 39 I3: 39 C: 39 | Modelled for lifetime | Regular PA of an aerobic type 2–3 times/week lasting 30–45 min | Not mentioned but included 3 visits to a physician | SEK 180 470 (£12 263) (£15 873) per LYG for exercise compared to no intervention | |
| Over et al,47 Netherlands, good | GP counselling in addition to pedometers to increase PA; healthcare, 2009 | Economic modelling; CUA | Two scenarios S1: pedometer use with diary and GP counselling S2: current practice (no additional advice) | Insufficiently active 20–65 years | Modelled for lifetime | 150 min of MPA per week | Not mentioned but included 10 min GP counselling | €11 100 (£8401) (£8858) per QALY | |
| Pringle et al,38 UK, fair | Community-based interventions to increase MPA; NHS, 2003 | Alongside single clinical and cost study; CEA, CUA | Seven intervention categories: campaigns, exercise classes, exercise referral, motivational interviews, outdoor activity, peer-mentoring, training of PA leaders | Inactive; 343 young people and 641 adults, particularly those aged 65 years and over | Modelled for lifetime using the Matrix model16 | 150 min of MPA per week | Not mentioned | £260-£1253 (£318-£1531) per completer improving MPA | £47-£229 (£57-£280) per QALY |
| Shaw et al,39 Scotland, fair | Pedometer-based walking; health services, 2008 | RCT; CEA | I: minimal intervention (walking programme and pedometer) I2: maximal intervention (PA consultation, pedometer and individualised walking programme) C: ‘usual behaviour’ | 18–65 years olds I1: 40 I2: 39 | 12 months | Weekly increase of ≥15 000 steps | 30 min | £92 (£99) (minimal vs control) £591 (£637) (maximal vs minimal) | |
| Sims et al,45 Australia, fair | Active script in general practice; health service, 1996 | Economic modelling; CEA, CUA | I: ASP—improving systematic PA advice by GPs C: routine GP care (no PA advice) | Less active adults aged 20–75 years, 670 GP advising sedentary patients I: 40 258 C: 10 437 | Unclear time horizon | 150 min of MPA per week | 4 min GP consultation | $A138 (£70) (£96) per patient to become active | $A3647 (£1838) (£2542) per DALY saved |
ASP, Active Script Programme; CEA, cost-effectiveness analysis; CUA, cost-utility analysis; DALY, disability adjusted life year; GP, general practitioner; GPRD, general practice research database; ICER, incremental cost-effectiveness ratio; LYG, life years gained; METs, metabolic equivalents; MPA, moderate-intensity physical activity; NHS, National Health Service (England); NZD, New Zealand Dollar; PA, physical activity; QALY, quality-adjusted life year; RCT, randomised controlled trial; SEK, Swedish krona; VPA, vigorous-intensity physical activity.