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Cost-effectiveness of physical activity interventions in adolescents: model development and illustration using two exemplar interventions.

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Suhrcke, Marc 
Atkin, Andrew J 
van Sluijs, Esther 
Turner, David 


OBJECTIVE: To develop a model to assess the long-term costs and health outcomes of physical activity interventions targeting adolescents. DESIGN: A Markov cohort simulation model was constructed with the intention of being capable of estimating long-term costs and health impacts of changes in activity levels during adolescence. The model parameters were informed by published literature and the analysis took a National Health Service perspective over a lifetime horizon. Univariate and probabilistic sensitivity analyses were undertaken. SETTING: School and community. PARTICIPANTS: A hypothetical cohort of adolescents aged 16 years at baseline. INTERVENTIONS: Two exemplar school-based: a comparatively simple, after-school intervention and a more complex multicomponent intervention compared with usual care. PRIMARY AND SECONDARY OUTCOME MEASURES: Incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained. RESULTS: The model gave plausible estimates of the long-term effect of changes in physical activity. The use of two exemplar interventions suggests that the model could potentially be used to evaluate a number of different physical activity interventions in adolescents. The key model driver was the degree to which intervention effects were maintained over time. CONCLUSIONS: The model developed here has the potential to assess long-term value for money of physical activity interventions in adolescents. The two applications of the model indicate that complex interventions may not necessarily be the ones considered the most cost-effective when longer-term costs and consequences are taken into account.



cost-effectiveness, health economics, physical activity, young adult, Adolescent, Cost-Benefit Analysis, Exercise, Female, Humans, Male, Markov Chains, Primary Health Care, Program Evaluation, Quality of Life, Schools

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BMJ Open

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Medical Research Council (MC_UU_12015/7)
Medical Research Council (MR/K023187/1)
Department of Health (via National Institute for Health Research (NIHR)) (PR-R5-0213-25001)
This report is an independent research commissioned and funded by the Department of Health Policy Research Programme (opportunities within the school environment to shift the distribution of activity intensity in adolescents, PR-R5-0213-25001). The views expressed in this publication are those of the author(s) and not necessarily those of the Department of Health. This work was also supported by the Medical Research Council (unit programme number: MC_UU_12015/7). The work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust (MR/K023187/1).