Cost-effectiveness of alternative approaches for motivating activity in sedentary adults: Results of Project STRIDE

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Abstract

Objective.

To evaluate the cost-effectiveness of non-face-to-face interventions for increasing physical activity in sedentary adults. The study took place in Providence, Rhode Island between the years 2000 and 2004.

Methods.

Two hundred and thirty-nine participants were randomized to Phone, Print or a contact control. Phone and Print groups were mailed regular surveys regarding their level of physical activity, motivational readiness and self-efficacy. Surveys were scanned by a computer expert system to generate feedback reports. Phone group participants received feedback by telephone. Print group participants received feedback by mail. The contact control group received mailings unrelated to physical activity. Intervention costs were assessed prospectively, from a payer perspective. Physical activity was measured using the 7-day Physical Activity Recall. Ambulatory health service use was assessed via monthly surveys.

Results.

The Print intervention was more economically efficient than the Phone intervention in engaging participants in a more active lifestyle.

Conclusion.

The Print intervention provides an efficient approach to increasing physical activity. Research is needed to determine the cost-effectiveness of the intervention in a more diverse population, within the context of the health service delivery system and over a longer period of time.

Introduction

Over a decade ago the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) published a joint summary statement on the health benefits of physical activity and recommended an accumulation of at least 30 min of moderate intensity physical activity on most days of the week (Pate et al., 1995). Consistent with this recommendation, Healthy People 2010 identified the need to increase the proportion of adults who meet this physical activity goal (U.S. Department of Health and Human Services, 2000). Unfortunately, many adults in the United States engage in little or no physical activity. Only about 25% of Americans meet the recommended levels of physical activity (Centers for Disease Control, 2001), and about 25% of the population engages in no leisure-time physical activity (Centers for Disease Control, 2004).

Physical inactivity contributes to many disease states including diabetes, cardiovascular disease, hypertension, colon cancer, osteoarthritis and osteoporosis (Ewing et al., 2003). The burden of chronic disease due to sedentary lifestyles can be measured in both physical and economic costs. The financial burden of physical inactivity to the U.S. health care system from cardiovascular disease alone was estimated to be over $23 billion in 2001 (Wang et al., 2004). Thus, there is substantial motivation to identify effective interventions that can be used to increase physical activity in the general public.

Recent meta-analyses have shown home-based physical activity interventions to be more effective than center-based interventions (Hillsdon and Thorogood, 1996) and interventions not involving face-to-face contact to have larger effect sizes (Dishman and Buckworth, 1996). Such approaches are also likely to be more economical than center-based interventions. However, few cost analyses of physical activity interventions appear in the literature. These include primary care-based counseling (Stevens et al., 1998, Elley et al., 2004), worksite counseling (Proper et al., 2004) and center-based physical activity interventions (Sevick et al., 2000; see summaries in Table 1). No studies were found comparing the cost-effectiveness of alternative intervention approaches that do not involve face-to-face contact. With this report we evaluate the cost-effectiveness of two intervention approaches that do not require face-to-face contact and that may have broad reach within the population of sedentary adults: (1) a telephone-based, individualized motivationally tailored feedback intervention and (2) a print-based, individualized motivationally tailored feedback.

Section snippets

Design

STRIDE was a randomized, controlled trial to evaluate the effectiveness of interventions delivering theory-based, motivationally tailored individualized feedback to sedentary adults, with the goal of increasing physical activity. Participants were randomized to one of three groups: (1) telephone-based intervention [Phone]; (2) print-based intervention [Print]; or (3) contact control (Marcus et al., 2007, Marcus et al., in press). Block randomization was performed, with blocks defined as stage

Results

Fig. 1 shows that the Phone and Print groups had an equivalent improvement in physical activity at 6 months, compared to the contact control (Marcus et al., in press). At 12 months, physical activity declined for the Phone group while the Print group continued to experience increases in time devoted to physical activity. Table 4 outlines the 6- and 12-month PAR results, including incremental cost (i.e., difference in cost between the contact control and intervention arms) and incremental

Discussion

It is clear from the results that the Print intervention was not only more effective than Phone for improving physical activity, it was also more cost-effective. While the per participant cost of the Project STRIDE Print intervention ($480 at 12 months) was somewhat greater than the primary care-based interventions by Stevens et al. (1998) ($117) and Elley et al. (2004) ($120) that were described earlier in this report, the cost of successfully engaging one participant in a more active

Conclusion

The Print intervention is an efficient approach to increasing activity in healthy but sedentary adults and requires a modest investment (about $40 per participant per month for a 12-month program) on the part of the payer. While, these costs may appear large in comparison to the brief, primary care-based programs evaluated by Stevens et al. (1998) and Elley et al. (2004), STRIDE appears to be more efficient in successfully engaging people in a more active lifestyle. Additional research is

Acknowledgments

This research was supported in part through a grant from the National Heart, Lung, and Blood Institute (#HL64342). The authors would like to acknowledge the individual contributions of: Linda Christian, RN, Robin Cram, M.F.A., Lisa Cronkite, B.S., Santina Ficara, B.S., Maureen Hamel, B.S., Beth Lewis, PhD., Jaime Longval, M.S., Kenny McParlin, Hazel Ouellette, Susan Pinheiro, B.A., Regina Traficante, Ph.D., Jessica Whiteley, PhD., and Kate Williams, B.S.

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