title: Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial.
abstract: OBJECTIVE
  To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults.
  
  
  METHODS
  Pragmatic, cluster randomised community intervention trial.
  
  
  METHODS
  12 general practices in Sheffield; four randomly selected as intervention populations, and eight as control populations.
  
  
  METHODS
  All those aged 65 and over in the least active four fifths of the population responding to a baseline survey. There were 2283 eligible participants from intervention practices and 4137 from control practices.
  
  
  METHODS
  Eligible subjects were invited to free locally held exercise classes, made available for two years.
  
  
  METHODS
  All cause and exercise related cause specific mortality and hospital service use at two years, and health status assessed at baseline, one, and two years using the SF-36. A cost utility analysis was also undertaken.
  
  
  RESULTS
  Twenty six per cent of the eligible intervention practice population attended one or more exercise sessions. There were no significant differences in mortality rates, survival times, or admissions. After adjusting for baseline characteristics, patients in intervention practices had a lower decline in health status, although this reached significance only for the energy dimension and two composite scores (p<0.05). The incremental average QALY gain of 0.011 per person in the intervention population resulted in an incremental cost per QALY ratio of 17 174 (95% CI = 8300 to 87 120).
  
  
  CONCLUSIONS
  Despite a low level of adherence to the exercise programme, there were significant gains in health related quality of life. The programme was more cost effective than many existing medical interventions, and would be practical for primary care commissioning agencies to implement.
authors.affiliation: Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. j.f.munro@sheffield.ac.uk
authors.forename: James F
authors.initials: JF
authors.lastname: Munro
authors.forename: Jon P
authors.initials: JP
authors.lastname: Nicholl
authors.forename: John E
authors.initials: JE
authors.lastname: Brazier
authors.forename: Rachel
authors.initials: R
authors.lastname: Davey
authors.forename: Tom
authors.initials: T
authors.lastname: Cochrane
mesh_terms: D000368:Aged; D003153:Community Health Services / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D015444:Exercise / Q000523:psychology; D005260:Female; D006293:Health Promotion / Q000191:economics* / Q000379:methods; D006296:Health Services / Q000706:statistics & numerical data; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009026:Mortality; D015397:Program Evaluation; D011634:Public Health / Q000191:economics / Q000379:methods; D011788:Quality of Life