title: Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability.
abstract: BACKGROUND
  Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention.
  
  
  METHODS
  The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150 min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon.
  
  
  RESULTS
  The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions.
  
  
  CONCLUSIONS
  The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.
authors.affiliation: Department of Family Medicine and Public Health, University of California San Diego, La Jolla. VA San Diego Healthcare System, California. egroessl@ucsd.edu.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Groessl
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, Maryland.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kaplan
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, California.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Castro Sweet
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge.
authors.forename: Timothy
authors.initials: T
authors.lastname: Church
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Espeland
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.
authors.forename: Nancy W
authors.initials: NW
authors.lastname: Glynn
authors.affiliation: Department of Health Research & Policy and Medicine, Stanford University School of Medicine, California.
authors.forename: Abby C
authors.initials: AC
authors.lastname: King
authors.affiliation: Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kritchevsky
authors.affiliation: Department of Aging and Geriatric Research, University of Florida, Gainesville.
authors.forename: Todd
authors.initials: T
authors.lastname: Manini
authors.affiliation: Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.affiliation: Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Kieran F
authors.initials: KF
authors.lastname: Reid
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Julia
authors.initials: J
authors.lastname: Rushing
authors.affiliation: Department of Aging and Geriatric Research, University of Florida, Gainesville.
authors.forename: Marco
authors.initials: M
authors.lastname: Pahor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D006266:Health Education / Q000191:economics*; D006801:Humans; D008019:Life Style; D008297:Male; D051346:Mobility Limitation; D004856:Postural Balance; D011788:Quality of Life; D014481:United States; D016138:Walking
keywords: Cost-effectiveness; Older adults; Physical activity