title: Cost-effectiveness and cost-utility of a Web-based or print-delivered tailored intervention to promote physical activity among adults aged over fifty: an economic evaluation of the Active Plus intervention.
abstract: BACKGROUND
  The adverse health effects of insufficient physical activity (PA) result in high costs to society. The economic burden of insufficient PA, which increases in our aging population, stresses the urgency for cost-effective interventions to promote PA among older adults. The current study provides insight in the cost-effectiveness and cost-utility of different versions of a tailored PA intervention (Active Plus) among adults aged over fifty.
  
  
  METHODS
  The intervention conditions (i.e. print-delivered basic (PB; N = 439), print-delivered environmental (PE; N = 435), Web-based basic (WB; N = 423), Web-based environmental (WE; N = 432)) and a waiting-list control group were studied in a clustered randomized controlled trial. Intervention costs were registered during the trial. Health care costs, participant costs and productivity losses were identified and compared with the intervention effects on PA (in MET-hours per week) and quality-adjusted life years (QALYs) 12 months after the start of the intervention. Cost-effectiveness ratios (ICERs) and cost-utility ratios (ICURs) were calculated per intervention condition. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty.
  
  
  RESULTS
  As a whole (i.e. the four intervention conditions together) the Active Plus intervention was found to be cost-effective. The PB-intervention (ICER = €-55/MET-hour), PE-intervention (ICER = €-94/MET-hour) and the WE-intervention (ICER = €-139/MET-hour) all resulted in higher effects on PA and lower societal costs than the control group. With regard to QALYs, the PB-intervention (ICUR = €38,120/QALY), the PE-intervention (ICUR = €405,892/QALY) and the WE-intervention (ICUR = €-47,293/QALY) were found to be cost-effective when considering a willingness-to-pay threshold of €20,000/QALY. In most cases PE had the highest probability to be cost-effective.
  
  
  CONCLUSIONS
  The Active Plus intervention was found to be a cost-effective manner to increase PA in a population aged over fifty when compared to no-intervention. The tailored Active Plus intervention delivered through printed material and with additional environmental information (PE) turned out to be the most cost-effective intervention condition as confirmed by the different sensitivity analyses. By increasing PA at relatively low costs, the Active Plus intervention can contribute to a better public health.
  
  
  BACKGROUND
  Dutch Trial Register: NTR2297.
authors.forename: Rianne Hj
authors.initials: RH
authors.lastname: Golsteijn
authors.forename: Denise A
authors.initials: DA
authors.lastname: Peels
authors.forename: Silvia Maa
authors.initials: SM
authors.lastname: Evers
authors.forename: Catherine
authors.initials: C
authors.lastname: Bolman
authors.forename: Aart N
authors.initials: AN
authors.lastname: Mudde
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
authors.forename: Lilian
authors.initials: L
authors.lastname: Lechner
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D020407:Internet / Q000191:economics*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012680:Sensitivity and Specificity