Cost-effectiveness of telephone coaching for physically inactive ambulatory care hospital patients: economic evaluation alongside the Healthy4U randomised controlled trial

• Published in: BMJ open 2019-12, Vol.9 (12), p.e032500-e032500
• Main Authors: Barrett, Stephen, Begg, Stephen, O'Halloran, Paul, Kingsley, Michael
• Format: Article
• Language: English
• Subjects: Ambulatory care; Behavior modification; Chronic illnesses; Coaching; Cost analysis; Economic impact; Economics; Education; Emergency medical services; Estimates; Health care expenditures; Health Economics; Hospitals; Intervention; Public health; Quality of life; Sensitivity analysis
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-032500

ObjectiveTo assess whether telephone coaching is a cost-effective method for increasing physical activity and health-related quality of life for insufficiently active adults presenting to an ambulatory care clinic in a public hospital.DesignAn economic evaluation was performed alongside a randomised controlled trial.SettingParticipants were recruited from an ambulatory care clinic in a public hospital in regional Australia.ParticipantsSeventy-two adults (aged 18–69) deemed insufficiently physically active via self-report.InterventionsParticipants were randomised to either an intervention group that received an education session and eight sessions of telephone coaching over a 12-week period, or to a control group that received the education session only. The intervention used in the telephone coaching was integrated motivational interviewing and cognitive behavioural therapy.Outcome measuresThe primary health outcome was change in moderate-to-vigorous physical activity (MVPA), objectively measured via accelerometry. The secondary outcome was the quality-adjusted life-year (QALY) determined by the 12-item Short Form Health Survey Questionnaire. Outcome data were measured at baseline, postintervention (3 months) and follow-up (6 months). Incremental cost-effectiveness ratios (ICERs) were calculated for each outcome. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty.ResultsThe mean intervention cost was $279±$13 per person. At 6 months follow-up, relative to control, the intervention group undertook 18 more minutes of daily MVPA at an ICER of $15/min for each additional minute of MVPA. With regard to QALYs, the intervention yielded an ICER of $36 857 per QALY gained. Sensitivity analyses indicated that results were robust to varied assumptions.ConclusionTelephone coaching was a low-cost strategy for increasing MVPA and QALYs in insufficiently physically active ambulatory care hospital patients. Additional research could explore the potential economic impact of the intervention from a broader healthcare perspective.Trial registration numberANZCTR: ACTRN12616001331426.