title: Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial.
abstract: BACKGROUND
  A recent HTA review concluded that there was a need for RCTs of exercise referral schemes (ERS) for people with a medical diagnosis who might benefit from exercise. Overall, there is still uncertainty as to the cost-effectiveness of ERS. Evaluation of public health interventions places challenges on conventional health economics approaches. This economic evaluation of a national public health intervention addresses this issue of where ERS may be most cost effective through subgroup analysis, particularly important at a time of financial constraint.
  
  
  METHODS
  This economic analysis included 798 individuals aged 16 and over (55% of the randomised controlled trial (RCT) sample) with coronary heart disease risk factors and/or mild to moderate anxiety, depression or stress. Individuals were referred by health professionals in a primary care setting to a 16 week national exercise referral scheme (NERS) delivered by qualified exercise professionals in local leisure centres in Wales, UK. Health-related quality of life, health care services use, costs per participant in NERS, and willingness to pay for NERS were measured at 6 and 12 months.
  
  
  RESULTS
  The base case analysis assumed a participation cost of £385 per person per year, with a mean difference in QALYs between the two groups of 0.027. The incremental cost-effectiveness ratio was £12,111 per QALY gained. Probabilistic sensitivity analysis demonstrated an 89% probability of NERS being cost-effective at a payer threshold of £30,000 per QALY. When participant payments of £1 and £2 per session were considered, the cost per QALY fell from £12,111 (base case) to £10,926 and £9,741, respectively. Participants with a mental health risk factor alone or in combination with a risk of chronic heart disease generated a lower ICER (£10,276) compared to participants at risk of chronic heart disease only (£13,060).
  
  
  CONCLUSIONS
  Results of cost-effectiveness analyses suggest that NERS is cost saving in fully adherent participants. Though full adherence to NERS (62%) was higher for the economics sample than the main sample (44%), results still suggest that NERS can be cost-effective in Wales with respect to existing payer thresholds particularly for participants with mental health and CHD risk factors.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN47680448.
authors.affiliation: Centre for Health Economics & Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Dean Street Building, Bangor LL57 1UT, UK. r.t.edwards@bangor.ac.uk.
authors.forename: Rhiannon Tudor
authors.initials: RT
authors.lastname: Edwards
authors.forename: Pat
authors.initials: P
authors.lastname: Linck
authors.forename: Natalia
authors.initials: N
authors.lastname: Hounsome
authors.forename: Larry
authors.initials: L
authors.lastname: Raisanen
authors.forename: Nefyn
authors.initials: N
authors.lastname: Williams
authors.forename: Laurence
authors.initials: L
authors.lastname: Moore
authors.forename: Simon
authors.initials: S
authors.lastname: Murphy
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000191:economics / Q000458:organization & administration*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D011788:Quality of Life; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration*; D014852:Wales