title: How much will we pay to increase steps per day? Examining the cost-effectiveness of a pedometer-based lifestyle program in primary care.
abstract: We previously demonstrated the Healthy Eating and Active Living for Diabetes (HEALD) intervention was effective for increasing daily steps. Here, we consider the cost-effectiveness of the HEALD intervention implemented in primary care. HEALD was a pedometer-based program for adults with type-2 diabetes in Alberta, Canada completed between January 2010 and September 2012. The main outcome was the change in pedometer-determined steps/day compared to usual care. We estimated total costs per participant for HEALD, and total costs of health care utilization through linkage with administrative health databases. An incremental cost-effectiveness ratio (ICER) was estimated with regression models for differences in costs and effects between study groups. The HEALD intervention cost $340 per participant over the 6-month follow-up. The difference in total costs (intervention plus health care utilization) was $102 greater per HEALD participant compared to usual care. The intervention group increased their physical activity by 918 steps/day [95% CI 116, 1666] compared to usual care. The resulting ICER was $111 per 1000 steps/day, less than an estimated cost-effectiveness threshold. Increasing daily steps through an Exercise Specialist-led group program in primary care may be a cost-effective approach towards improving daily physical activity among adults with type-2 diabetes. Alternative delivery strategies may be considered to improve the affordability of this model for primary care.
authors: Faulty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB T9S 3A3, Canada.
authors: S T
authors: ST
authors: Johnson
authors: Institute of Health Economics, #1200, 10405 Jasper Ave, Edmonton, AB T5J 3N4, Canada.
authors: D A
authors: DA
authors: Lier
authors: Institute of Health Economics, #1200, 10405 Jasper Ave, Edmonton, AB T5J 3N4, Canada.
authors: A
authors: A
authors: Soprovich
authors: School of Public Health, 3-300 ECHA, University of Alberta, Edmonton, AB T6G 1C9, Canada.
authors: C
authors: C
authors: Mundt
authors: School of Public Health, 3-300 ECHA, University of Alberta, Edmonton, AB T6G 1C9, Canada.
authors: J A
authors: JA
authors: Johnson
keywords: Cost; Diabetes; Exercise specialists; Pedometers; Primary care; Walking