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Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia
  1. Jennifer C Davis1,2,3,
  2. Stirling Bryan1,2,
  3. Carlo A Marra4,5,
  4. Ging-Yuek R Hsiung6,7,
  5. Teresa Liu-Ambrose3,7,8
  1. 1Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
  2. 2School of Population and Public Health, University of British Columbia, Vancouver, Canada
  3. 3Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada
  4. 4Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
  5. 5Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada
  6. 6Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
  7. 7Brain Research Centre, Vancouver Coastal Research Institute, University of British Columbia, Vancouver, Canada
  8. 8Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Research Institute, Vancouver, Canada
  1. Correspondence to Dr Jennifer C Davis, Centre for Clinical Epidemiology and Evaluation, Vancouver Costal Health Research Institute|The University of British Columbia, 7th floor, 828 West 10th Avenue, Vancouver, BC, Canada V5Z 1M9; Jennifer.davis{at}


Background Cognitive decline is one of the most prominent healthcare issues of the 21st century. Within the context of combating cognitive decline through behavioural interventions, physical activity is a promising approach. There is a dearth of health economic data in the area of behavioural interventions for dementia prevention. Yet, economic evaluations are essential for providing information to policy makers for resource allocation. It is essential we first address population and intervention-specific methodological challenges prior to building a larger evidence base. We use a cost-utility analysis conducted alongside the exercise for cognition and everyday living (EXCEL) study to illustrate methodological challenges specific to assessing the cost-effectiveness of behavioural interventions aimed at older adults at risk of cognitive decline.

Methods A cost-utility analysis conducted concurrently with a 6-month, three-arm randomised controlled trial (ie, the EXCEL study) was used as an example to identify and discuss methodological challenges.

Results Both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. In critically evaluating the economic evaluation of the EXCEL study we identified four category-specific challenges: (1) analysing costs; (2) assessing quality-adjusted life-years; (3) Incomplete data; and (4) ‘Intervention’ activities of the control group.

Conclusions Resistance training and aerobic training resulted in healthcare cost saving and were equally effective to balance and tone classes after only 6 months of intervention. To ensure this population is treated fairly in terms of claims on resources, we first need to identify areas for methodological improvement.

  • Exercise
  • Physical activity and exercise methodology
  • Physical activity promotion in primary care
  • Walking
  • Weight lifting

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