title: Cost-effectiveness of a physical exercise programme for residents of care homes: a pilot study.
abstract: BACKGROUND
  Oomph! Wellness organises interactive exercise and activity classes (Oomph! classes) for older people in care homes. We investigated the cost-effectiveness of Oomph! classes.
  
  
  METHODS
  Health-related quality of life was measured using the EQ-5D-5 L questionnaire at three time points; 3 months and 1 week prior to the start of the classes and after 3 months of Oomph! classes. Costs included the costs of organising the classes, training instructors and health service use (General Practitioner (GP) and hospital outpatient visits). To determine the cost-effectiveness of Oomph! classes, total costs and quality-adjusted life-years (QALYs) during the 3 months after initiation of the classes were compared to the total costs and QALYs of the 3 months prior to the classes and extrapolated to a 1-year time horizon. Uncertainty was taken into account using one-way and probabilistic sensitivity analysis.
  
  
  RESULTS
  Sixteen residents completed all three EQ-5D-5 L questionnaires. There was a decrease in mean health related quality of life per participant in the 3 months before Oomph! classes (0.56 to 0.52, p = 0.26) and an increase in the 3 months after the start of Oomph! classes (0.52 to 0.60, p = 0.06), but the changes were not statistically significant. There were more GP visits after the start of Oomph! classes and fewer hospital outpatient visits, leading to a slight decrease in NHS costs (mean £132 vs £141 per participant), but the differences were not statistically significant (p = 0.79). In the base case scenario, total costs for Oomph! classes were £113 higher per participant than without Oomph! classes (£677 vs £564) and total QALYs were 0.074 higher (0.594 vs 0.520). The incremental costs per QALY gained were therefore £1531. The 95 % confidence intervals around the cost/QALY gained varied from dominant to dominated, meaning there was large uncertainty around the cost-effectiveness results. Given a willingness to pay threshold of £20,000 per QALY gained, Oomph! classes had a 62 %-86 % probability of being cost-effective depending on the scenario used.
  
  
  CONCLUSIONS
  Preliminary evidence suggests that Oomph! classes may be cost-effective, but further evidence is needed about its impact on health-related quality of life and health service use.
authors.affiliation: Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK. t.verhoef@ucl.ac.uk.
authors.forename: Talitha I
authors.initials: TI
authors.lastname: Verhoef
authors.affiliation: Oomph! Wellness Ltd, London, UK.
authors.forename: Parita
authors.initials: P
authors.lastname: Doshi
authors.affiliation: Oomph! Wellness Ltd, London, UK.
authors.forename: Dan
authors.initials: D
authors.lastname: Lehner
authors.affiliation: Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000379:methods; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005260:Female; D006296:Health Services / Q000191:economics*; D006707:Homes for the Aged / Q000191:economics*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires
keywords: Care homes; Cost-effectiveness; Physical activity; Quality of life