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Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial
Gusi N, Reyes MC, Gonzalez-Guerrero JL, Herrera E, Garcia JM
BMC Public Health 2008 Jul 8;8(231):Epub
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: There is a considerable public health burden due to physical inactivity, because it is a major independent risk factor for several diseases (eg, type 2 diabetes, cardiovascular disease, moderate mood disorders neurotic diseases such as depression, etc). This study assesses the cost utility of the adding a supervised walking programme to the standard "best primary care" for overweight, moderately obese, or moderately depressed elderly women. METHODS: One-hundred six participants were randomly assigned to an interventional group (n = 55) or a control group (n = 51). The intervention consisted of an invitation, from a general practitioner, to participate in a 6-month walking-based, supervised exercise program with three 50-minute sessions per week. The main outcome measures were the healthcare costs from the Health System perspective and quality adjusted life years (QALYs) using EuroQol (EQ-5D). RESULTS: Of the patients invited to participate in the program, 79% were successfully recruited, and 86% of the participants in the exercise group completed the programme. Over 6 months, the mean treatment cost per patient in the exercise group was Euro 41 more than "best care". The mean incremental QALY of intervention was 0.132 (95% CI 0.104 to 0.286). Each extra QALY gained by the exercise programme relative to best care cost Euro 311 (95% CI 143 to 394). The cost effectiveness acceptability curves showed a 90% probability that the addition of the walking programme is the best strategy if the ceiling of inversion is 350 Euro /QALY. CONCLUSION: The invitation strategy and exercise programme resulted in a high rate of participation and is a feasible and cost-effective addition to best care. The programme is a cost-effective resource for helping patients to increase their physical activity, according to the recommendations of general practitioners. Moreover, the present study could help decision makers enhance the preventive role of primary care and optimize health care resources. TRIAL REGISTRATION: ISRCTN98931797.

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