Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial.
OBJECTIVE
To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans.


METHODS
Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance, physical activity, function, disability, and medical resource use and cost.


METHODS
Veterans Affairs Medical Center, Durham, North Carolina.


METHODS
Male veterans aged ≥70 years (n = 398).


METHODS
An experienced health counselor provided baseline in-person exercise counseling, followed by telephone counseling at 2, 4, and 6 weeks, and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention, followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly.


METHODS
Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated.


RESULTS
The total direct cost of the intervention per participant was $459, 85% of which was counselor effort. With overhead, program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention, versus $12,052 with usual care (difference = -$1,634 (95% confidence interval = -$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes, the intervention cost $4,971 per additional patient reaching target exercise levels, or $4,640 per patient achieving a clinically significant change in rapid gait speed.


CONCLUSIONS
Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Patricia A
http://orcid.org/0000-0002-5850-5912
PA
Cowper
Departments of Community Health and Geriatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
Matthew J
MJ
Peterson
Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC.|Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
Carl F
CF
Pieper
Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC.|School of Nursing, Duke University Medical Center, Durham, North Carolina.
Richard J
RJ
Sloane
Department of Medicine, Duke University Medical Center, Durham, North Carolina.|Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC.|Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC.
Katherine S
KS
Hall
Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC.|School of Nursing, Duke University Medical Center, Durham, North Carolina.|Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC.
Eleanor S
ES
McConnell
Department of Medicine, Duke University Medical Center, Durham, North Carolina.|Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC.|School of Nursing, Duke University Medical Center, Durham, North Carolina.|Health Services Research and Development Service, VA Medical Center, Durham, NC.
Hayden B
HB
Bosworth
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
Carola C
CC
Ekelund
Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC.
Megan P
MP
Pearson
Department of Medicine, Duke University Medical Center, Durham, North Carolina.|Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC.|Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC.
Miriam C
MC
Morey
D000368:Aged; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D015444:Exercise; D017048:Health Care Costs / Q000706:statistics & numerical data; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008297:Male; D009657:North Carolina; D011320:Primary Health Care / Q000191:economics*; D015397:Program Evaluation / Q000191:economics; D014728:Veterans; D000072797:Walking Speed
cost; counseling; physical activity; randomized clinical trial