Table 3

Cost-effectiveness studies undertaken of interventions that included physical activity counselling or intervention within primary care or the community (published from 2002 to 2009).

Study details and qualityObjective; economic perspectiveStudy type; economic analysis typeInterventions (I) and comparison (C)Participants, number in each groupFollow-up duration (months)Annual cost per participant to become active, (€at time of study) [inflated to June 2008]Cost of shifting to active categorya, (€at time of study) [inflated to June 2008]Cost per QALY (€ at time of study) [inflated to June 2008]
UK Beam Trial Team,17 UK: ExcellentPrimary care, multifaceted intervention for low back pain; health funder, 2000–2001RCT; CUAI1: exercise programme; I2: spinal manipulation; I3: combined; C: usual careParticipants consulting GP for low back pain: I1: 29712£8235b (€13 423) [€15 860]
I2: 342
I3: 322
C: 326
Cochrane et al,18 UK: ExcellentPrimary care/community water exercise programme; societal costs, 2002RCT; CEAI1: water-based exercise, C: usual careOlder participants with hip and/or knee OA: I1: 15312£5008c (€7963) [€9160]
C: 159
Hurley et al,19 UK: ExcellentPrimary care, Knee rehabilitation; societal costs, 2003Cluster RCT; CEA, CUAI1: individual rehabilitation,d I2: group-based rehabilitation,d C: usual primary careParticipants ≥50 years attending primary care for mild/moderate/severe knee pain, duration >6 months: I1: 1466Usual care produced greater QALY gain (0.0096) than individual rehabilitation (−0.0034) and group rehabilitation (0.0057), despite ‘functional improvements’ with exercise interventions
I2: 132
C: 140
Hollinghurst et al,20 UK: FairPrimary care; societal perspective, 20054 × 2 factorial RCT; CEAI1: short-course Alexander technique, I2: long-course Alexander technique, I3: massage, C: usual care groups; All also randomised into with or without GP exercise script and practice nurse exercise counsellingParticipants with chronic or recurrent low back pain: I1: 14412£2847 (€4157) [€4577] (exercise counselling and prescription for exercise compared with usual care)
I2: 144
I3: 147
C: 144
Gusi et al,21 Spain: PoorPrimary care, supervised walking programme; health funder, 2005RCT; CUAI1: walking-based, supervised programme (3 × 50 min/week), C: usual careWomen, ≥60 years with moderate depression or overweight: I1: 646€311 [€348]
C: 63
Handley et al,22 US: FairPrimary care-based automated telephone support; direct programme costs, June 2003 to December 2004RCT; CEA, CUAI1: automated telephone surveillance/support, nurse care management, C: usual careAdult English-, Spanish-, Cantonese-speaking primary care participants with type 2 diabetes: I1: 11212US $558e (€463) [€551]US $65 167 (€54 089), [€64 346]
C: 114
Sevick et al,23 US: ExcellentCommunity, physical activity counselling; health funder, 2004RCT; CEAI1: telephone-based feedback on PAf, I2: print-based feedback on PA, C: contact controlSedentary adults (18-65 years): I1: 8012$3967 (€3174) [€3673] (phone group); $955 (€764) [€884] (print group)
I2: 81
C: 78
Munro et al,24 UK: PoorPrimary care, exercise class; health funder, 2003/2004Cluster RCT; CUA, CEAI1: free, 2 × weekly (45 min) community-based exercise class, C: usual careParticipants ≥65 years assessed by survey as being in least-active four-fifths of the population: I1: 228324€17 174 [€19 425]
C: 4137
Dzator et al,25 Australia: FairPhysical activity/nutrition programme in community setting; direct programme costsRCT; CEAI1: high-level, interactive group sessions, I2: low-level, mailed intervention, C: no interventionCouplesh (mean age 28–31 years): I1: 47 couples12No significant effect difference between groups observed regarding the activity level: exercise days per weekAUS $460.44 (€267) [€350] (high level); AUS $458.61 (€266) [€349] (low level)
I2: 47 couples
C: 43 couples
Elley et al,11 New Zealand: ExcellentPrimary care exercise counselling/prescription; societal costs, 2001Cluster RCT; CEAI1: Green Prescription, counselling in general practice, C: usual careLess active primary care participants (40–79 years): I1: 45112€825 [€957] (activity level 5 × 30 min/week)NZ $1756g (€825) [€957]
C: 427
Dalziel et al,10 New Zealand: ExcellentPrimary care exercise counselling/prescription data from Elley's study;11 2001 costsCluster RCT; CUAI1: Green Prescription, counselling in general practice, C: usual careLess-active primary care participants (40–79 years): I1: 45112NZ$2053 (€965) [€1120]
C: 427
Isaacs et al,26 UK GoodPrimary care referral to exercise programmes; health funder, 2002 costsRCT; CEAI1: supervised, gym-based exercise classes,i I2: instructor-led walking programme,i C: advice and information onlyPhysically inactive 40–74 year olds with at least one cardiovascular risk factor: I1 31712I1: £19 500 (€31 005) [€35 665]; I2: £47 500 (€75 525) [€86 877]
I2: 311
C: 315
Elley et al,27 New Zealand: ExcellentPrimary care exercise counselling/prescription; societal costs, 2008RCT; CEAI1: enhanced Green Prescription, counselling in primary care, C: usual carePhysically inactive 40–74-year-old women24NZ $687 [€331] sustained at 12 months; NZ $1407 [€678] sustained at 24 months
  • a Undertaking at least 150 minutes of at least moderate-intensity physical activity per week.

  • b Exercise programme component only.

  • c 20% (n = 65) missing values for EuroQol-5D (EQ-5D) imputed by regression based on age, sex, and EuroQol-Visual Analogue Scale (EQ-VAS).

  • d 12 supervised sessions, 2 × weekly for 6 weeks (40 minutes to 1 hour) including information giving and exercises.

  • e Cost to achieve a 10% increase in the proportion of participants achieving moderate or vigorous physical activity.

  • f No significant difference between phone and control group at 12 months for PA measures.

  • g Programme cost of shifting one person from sedentary to active category.

  • h Variable proportion of participants reported as sufficiently active at baseline.

  • i Ten-week (2–3 times per week).

  • CEA = cost-effectiveness analysis. CUA = cost-utility analysis. OA = osteoarthritis. PA = physical activity. QALY = quality-adjusted life-year. RCT = randomised controlled trial.