Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Feb 1, 2023
Open Peer Review Period: Jul 14, 2024 - Sep 14, 2024
Date Accepted: May 16, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Cost-effectiveness of a nationwide physical activity intervention for diabetes and hypertension prevention: a modelling study of 654,500 adults
ABSTRACT
Background:
Increasing physical inactivity is a primary risk factor for diabetes and hypertension, contributing to rising healthcare expenditure and productivity losses. Large-scale physical activity interventions could potentially reduce the disease burden but face challenges in the uncertainty of long-term health impact and high implementation costs, hindering their adoption.
Objective:
We examined the cost-effectiveness of the Singapore National Steps Challenge (NSC), an annual nationwide mHealth intervention to increase physical activity.
Methods:
We used a Markov model to assess the long-term impact of increased physical activity from NSC on adults aged 17 and above. The model compared two situations: NSC conducted yearly for 10 years against no NSC. The model projected costs and mortality arising from diabetes and hypertension, and their complications. Health outcomes were expressed in terms of the quality-adjusted life-years (QALYs) gained. Sensitivity analyses were done to test the robustness of our model results.
Results:
We estimated that conducting NSC yearly for 10 years on a mean cohort size of 654,500 participants is projected to prevent 6,120 diabetes cases (95% credible interval 3,690 to 9,040), 10,300 hypertension cases (6,260 to 14,700) and 4,950 deaths (3,280 to 7,040). This led to a reduction in healthcare costs of SGD674 million (239 million to 1.48 billion). There would be 78,800 QALYs (56,500 to 102,000) gained. Using a willingness-to-pay threshold of SGD10,000 per QALY gained, NSC would be cost-saving at -SGD4,510 (-14,000 to 1,430) per QALY gained. When indirect costs were included, NSC would be cost-saving at -SGD21,000 (-54,800 to -4,530) per QALY gained. The model was most sensitive to changes in the cost of diabetes complications, time horizon and programme compliance.
Conclusions:
In this modelling study, increasing physical activity by conducting a yearly nationwide physical activity intervention was cost-saving, preventing diabetes and hypertension, and reducing mortality from these diseases.
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