JMIR Publications

ABSTRACT

Background:

Increasing adherence to physical activity (PA) guidelines could prevent chronic disease morbidity and mortality, save considerable healthcare costs, and reduce health disparities. We previously established the efficacy and cost-effectiveness of a web-based PA intervention for Latina women, which increased PA but few participants met PA guidelines and long-term maintenance was not examined. A new version with enhanced intervention features was found to outperform the original intervention in long-term guideline adherence.

Objective:

to determine the costs and cost-effectiveness of the enhanced multi-technology PA intervention vs. the original web-based intervention in increasing minutes of activity and adherence to guidelines

Methods:

Latina adults (N=195) were randomly assigned to receive a Spanish language individually tailored web-based PA intervention (Original), or the same intervention additional phone calls and interactive text messaging (Enhanced). PA was measured at baseline, 12 months (end of active intervention), and 24 months (end of tapered maintenance) using self-report (7-Day Physical Activity Recall Interview) and ActiGraph accelerometers. Costs were estimated from a payer perspective and included all features needed to deliver the intervention, including staff, materials, and technology. Cost effectiveness was calculated as the cost per additional minute of PA added over the intervention, and the incremental cost effectiveness ratios of each additional person meeting guidelines.

Results:

at 12 months, the costs of delivering the interventions were $16/person/month and $13/person/month in the Enhanced and Original arms, respectively. These costs fell to $14 and $8 at 24 months. At 12 months, each additional minute of self-reported activity in the Enhanced group cost $0.09 vs. $0.11 in Original ($0.19 vs. $0.16 for ActiGraph), with incremental costs of $0.05 per additional minute in Enhanced beyond Original. At the end of maintenance (24 months), costs per additional minute fell to $0.06 and $0.05 ($0.12 vs. $0.10 for ActiGraph), with incremental costs of $0.08 per additional minute in Enhanced ($0.20 for ActiGraph). Costs of meeting PA guidelines at 12 months were $705 vs. $503 in Enhanced vs. Original, and increased to $812 and $601 at 24 months. The ICER for meeting guidelines at 24 months was $1837 (95% CI $730.89-$2673.89) per additional person in the Enhanced vs. Original arm.

Conclusions:

As expected, the Enhanced intervention was more expensive, but yielded better long-term maintenance of activity. Both conditions were low costs relative to other medical interventions. The Enhanced intervention may be preferable in high risk populations, where more investment in meeting guidelines could yield more cost savings. Clinical Trial: NCT03491592