Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial

Tristan Snowsill; Afroditi Stathi; Colin Green; Janet Withall; Colin Greaves; Janice Thompson; Gordon Taylor; Selena Gray; Heidi Johansen-Berg; James Bilzon; Jolanthe De Koning; Jessica Boles; Sarah Moorlock; Max J. Western; Jack M Guralnik; W. Jack Rejeski; Kenneth R Fox; Antonieta Medina-Lara

doi:10.1016/S2468-2667(22)00030-5

Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial

Tristan Snowsill, Afroditi Stathi, Colin Green, Janet Withall, Colin Greaves, Janice Thompson, Gordon Taylor, Selena Gray, Heidi Johansen-Berg, James Bilzon, Jolanthe De Koning, Jessica Boles, Sarah Moorlock, Max J. Western, Jack M Guralnik, W. Jack Rejeski, Kenneth R Fox, Antonieta Medina-Lara

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Abstract

Background: Mobility limitations in older populations have a substantial impact on health outcomes, quality of life, and social care costs. The Retirement in Action (REACT) randomised controlled trial assessed a 12-month community-based group physical activity and behaviour maintenance intervention to help prevent decline in physical functioning in older adults at increased risk of mobility limitation. We aimed to do an economic evaluation of the REACT trial to investigate whether the intervention is cost-effective. Methods: In this health economic evaluation, we did cost-effectiveness and cost-utility analyses of the REACT programme versus standard care on the basis of resource use, primary outcome, and health-related quality-of-life data measured in the REACT trial. We also developed a decision analytic Markov model that forecasts the mobility of recipients beyond the 24-month follow-up of the trial and translated this into future costs and potential benefit to health-related quality of life using the National Health Service and Personal Social Services perspective. Participants completed questionnaire booklets at baseline, and at 6, 12, and 24 months after randomisation, which included a resource use questionnaire and the EQ-5D-5L and 36-item short-form survey (SF-36) health-related quality-of-life instruments. The cost of delivering the intervention was estimated by identifying key resources, such as REACT session leader time, time of an individual to coordinate the programme, and venue hire. EQ-5D-5L and SF-36 responses were converted to preference-based utility values, which were used to estimate quality-adjusted life-years (QALYs) over the 24-month trial follow-up using the area-under-the-curve method. We used generalised linear models to examine the effect of the REACT programme on costs and QALYs and adjust for baseline covariates. Costs and QALYs beyond 12 months were discounted at 3·5% per year. This is a pre-planned analysis of the REACT trial; the trial itself is registered with ISRCTN (ISRCTN45627165). Findings: The 12-month REACT programme was estimated to cost £622 per recipient to deliver. The most substantial cost components are the REACT session leader time (£309 per participant), venue hire (£109), and the REACT coordinator time (£80). The base-case analysis of the trial-based economic evaluation showed that reductions in health and social care usage due to the REACT programme could offset the REACT delivery costs (£3943 in the intervention group vs £4043 in the control group; difference: –£103 [95% CI −£695 to £489]) with a health benefit of 0·04 QALYs (0·009–0·071; 1·354 QALYs in the intervention group vs 1·314 QALYs in the control group) within the 24-month timeframe of the trial. Interpretation: The REACT programme could be considered a cost-effective approach for improving the health-related quality of life of older adults at risk of mobility limitations. Funding: National Institute for Health Research Public Health Research Programme.

Original language	English
Pages (from-to)	e327-e334
Journal	The Lancet Public Health
Volume	7
Issue number	4
Early online date	21 Mar 2022
DOIs	https://doi.org/10.1016/S2468-2667(22)00030-5
Publication status	Published - Apr 2022

Bibliographical note

Funding Information:
This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Funding Information:
This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Publisher Copyright:
© 2022 The Authors(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Keywords

Exercise
State Medicine
Cost-Benefit Analysis
Humans
Quality of Life
Aged
Retirement

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

Access to Document

10.1016/S2468-2667(22)00030-5Licence: Creative Commons: Attribution (CC BY)

SnowsillT2022CostefFinal published version, 570 KBLicence: Creative Commons: Attribution (CC BY)

4 Article

Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: the REACT (REtirement in ACTion) randomised controlled trial
Stathi, A., Greaves, C., Thompson, J., Withall, J., Ladlow, P., Taylor, G., Medina-Lara, A., Snowsill, T., Gray, S., Green, C., Johansen-Berg, H., Sexton, C., Bilzon, J., De Koning, J., Bollen, J., Moorlock, S., Western, M. J., Demnitz, N., Seager, P., Guralnik, J. M., & 3 othersRejeski, W. J., Hillsdon, M. & Fox, K., 21 Mar 2022, (E-pub ahead of print) In: The Lancet. Public health.
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Hippocampal maintenance after a 12-month physical activity intervention in older adults: The REACT MRI study
Demnitz, N., Stathi, A., Withall, J., Stainer, C., Seager, P., De Koning, J., Esser, P., Wassenaar, T., Dawes, H., Brooks, J., Ebmeier, K., Johansen-Berg, H. & Sexton, C., 2022, In: NeuroImage: Clinical. 35, 9 p., 102762.
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The tribulations of trials: lessons learnt recruiting 777 older adults into REtirement in ACTion (REACT) a community, group-based active ageing intervention targeting mobility disability.
REACT Study Research Group, Withall, J., Greaves, C., Thompson, J., De Koning, J., Bollen, J., Moorlock, S., Fox, K. R., Western, M., Snowsill, T., Medina-Lara, A., Cross, R., Ladlow, P., Taylor, G., Zisi, V., Clynes, J., Gray, S., Agyapong-Badu, S., Guralnik, J. M., Rejeski, W. J., & 1 othersStathi, A., 9 Mar 2020, In: The journals of gerontology. Series A, Biological sciences and medical sciences. 75, 12, p. 2387-2395 9 p.
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A community-based physical activity intervention to prevent mobility-related disability for retired older people (REtirement in ACTion [REACT]): study protocol for a randomised controlled trial
Stathi, A., Withall, J., Greaves, C., Thompson, J., Taylor, G., Medina-Lara, A., Green, C., Bilzon, J., Gray, S., Johansen-Berg, H., Sexton, C., Western, M., De Koning, J., Bollen, J., Moorlock, S., Demnitz, N., Seager, P., Guralnik, J. M., Rejeski, W. J. & Fox, K. R., 17 Apr 2018, In: Trials. 19, 228.
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Cite this

Snowsill, T., Stathi, A., Green, C., Withall, J., Greaves, C., Thompson, J., Taylor, G., Gray, S., Johansen-Berg, H., Bilzon, J., De Koning, J., Boles, J., Moorlock, S., Western, M. J., Guralnik, J. M., Rejeski, W. J., Fox, K. R., & Medina-Lara, A. (2022). Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial. The Lancet Public Health, 7(4), e327-e334. Advance online publication. https://doi.org/10.1016/S2468-2667(22)00030-5

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title = "Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial",

abstract = "Background: Mobility limitations in older populations have a substantial impact on health outcomes, quality of life, and social care costs. The Retirement in Action (REACT) randomised controlled trial assessed a 12-month community-based group physical activity and behaviour maintenance intervention to help prevent decline in physical functioning in older adults at increased risk of mobility limitation. We aimed to do an economic evaluation of the REACT trial to investigate whether the intervention is cost-effective. Methods: In this health economic evaluation, we did cost-effectiveness and cost-utility analyses of the REACT programme versus standard care on the basis of resource use, primary outcome, and health-related quality-of-life data measured in the REACT trial. We also developed a decision analytic Markov model that forecasts the mobility of recipients beyond the 24-month follow-up of the trial and translated this into future costs and potential benefit to health-related quality of life using the National Health Service and Personal Social Services perspective. Participants completed questionnaire booklets at baseline, and at 6, 12, and 24 months after randomisation, which included a resource use questionnaire and the EQ-5D-5L and 36-item short-form survey (SF-36) health-related quality-of-life instruments. The cost of delivering the intervention was estimated by identifying key resources, such as REACT session leader time, time of an individual to coordinate the programme, and venue hire. EQ-5D-5L and SF-36 responses were converted to preference-based utility values, which were used to estimate quality-adjusted life-years (QALYs) over the 24-month trial follow-up using the area-under-the-curve method. We used generalised linear models to examine the effect of the REACT programme on costs and QALYs and adjust for baseline covariates. Costs and QALYs beyond 12 months were discounted at 3·5% per year. This is a pre-planned analysis of the REACT trial; the trial itself is registered with ISRCTN (ISRCTN45627165). Findings: The 12-month REACT programme was estimated to cost £622 per recipient to deliver. The most substantial cost components are the REACT session leader time (£309 per participant), venue hire (£109), and the REACT coordinator time (£80). The base-case analysis of the trial-based economic evaluation showed that reductions in health and social care usage due to the REACT programme could offset the REACT delivery costs (£3943 in the intervention group vs £4043 in the control group; difference: –£103 [95% CI −£695 to £489]) with a health benefit of 0·04 QALYs (0·009–0·071; 1·354 QALYs in the intervention group vs 1·314 QALYs in the control group) within the 24-month timeframe of the trial. Interpretation: The REACT programme could be considered a cost-effective approach for improving the health-related quality of life of older adults at risk of mobility limitations. Funding: National Institute for Health Research Public Health Research Programme.",

keywords = "Exercise, State Medicine, Cost-Benefit Analysis, Humans, Quality of Life, Aged, Retirement",

author = "Tristan Snowsill and Afroditi Stathi and Colin Green and Janet Withall and Colin Greaves and Janice Thompson and Gordon Taylor and Selena Gray and Heidi Johansen-Berg and James Bilzon and {De Koning}, Jolanthe and Jessica Boles and Sarah Moorlock and Western, {Max J.} and Guralnik, {Jack M} and Rejeski, {W. Jack} and Fox, {Kenneth R} and Antonieta Medina-Lara",

note = "Funding Information: This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Funding Information: This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Publisher Copyright: {\textcopyright} 2022 The Authors(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license",

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month = apr,

doi = "10.1016/S2468-2667(22)00030-5",

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Snowsill, T, Stathi, A, Green, C, Withall, J , Greaves, C , Thompson, J, Taylor, G, Gray, S, Johansen-Berg, H, Bilzon, J, De Koning, J, Boles, J, Moorlock, S, Western, MJ, Guralnik, JM, Rejeski, WJ, Fox, KR & Medina-Lara, A 2022, 'Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial', The Lancet Public Health, vol. 7, no. 4, pp. e327-e334. https://doi.org/10.1016/S2468-2667(22)00030-5

Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial. / Snowsill, Tristan; Stathi, Afroditi; Green, Colin et al.
In: The Lancet Public Health, Vol. 7, No. 4, 04.2022, p. e327-e334.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults

T2 - an economic evaluation of the REACT (Retirement in Action) trial

AU - Snowsill, Tristan

AU - Stathi, Afroditi

AU - Green, Colin

AU - Withall, Janet

AU - Greaves, Colin

AU - Thompson, Janice

AU - Taylor, Gordon

AU - Gray, Selena

AU - Johansen-Berg, Heidi

AU - Bilzon, James

AU - De Koning, Jolanthe

AU - Boles, Jessica

AU - Moorlock, Sarah

AU - Western, Max J.

AU - Guralnik, Jack M

AU - Rejeski, W. Jack

AU - Fox, Kenneth R

AU - Medina-Lara, Antonieta

N1 - Funding Information: This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Funding Information: This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Publisher Copyright: © 2022 The Authors(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

PY - 2022/4

Y1 - 2022/4

N2 - Background: Mobility limitations in older populations have a substantial impact on health outcomes, quality of life, and social care costs. The Retirement in Action (REACT) randomised controlled trial assessed a 12-month community-based group physical activity and behaviour maintenance intervention to help prevent decline in physical functioning in older adults at increased risk of mobility limitation. We aimed to do an economic evaluation of the REACT trial to investigate whether the intervention is cost-effective. Methods: In this health economic evaluation, we did cost-effectiveness and cost-utility analyses of the REACT programme versus standard care on the basis of resource use, primary outcome, and health-related quality-of-life data measured in the REACT trial. We also developed a decision analytic Markov model that forecasts the mobility of recipients beyond the 24-month follow-up of the trial and translated this into future costs and potential benefit to health-related quality of life using the National Health Service and Personal Social Services perspective. Participants completed questionnaire booklets at baseline, and at 6, 12, and 24 months after randomisation, which included a resource use questionnaire and the EQ-5D-5L and 36-item short-form survey (SF-36) health-related quality-of-life instruments. The cost of delivering the intervention was estimated by identifying key resources, such as REACT session leader time, time of an individual to coordinate the programme, and venue hire. EQ-5D-5L and SF-36 responses were converted to preference-based utility values, which were used to estimate quality-adjusted life-years (QALYs) over the 24-month trial follow-up using the area-under-the-curve method. We used generalised linear models to examine the effect of the REACT programme on costs and QALYs and adjust for baseline covariates. Costs and QALYs beyond 12 months were discounted at 3·5% per year. This is a pre-planned analysis of the REACT trial; the trial itself is registered with ISRCTN (ISRCTN45627165). Findings: The 12-month REACT programme was estimated to cost £622 per recipient to deliver. The most substantial cost components are the REACT session leader time (£309 per participant), venue hire (£109), and the REACT coordinator time (£80). The base-case analysis of the trial-based economic evaluation showed that reductions in health and social care usage due to the REACT programme could offset the REACT delivery costs (£3943 in the intervention group vs £4043 in the control group; difference: –£103 [95% CI −£695 to £489]) with a health benefit of 0·04 QALYs (0·009–0·071; 1·354 QALYs in the intervention group vs 1·314 QALYs in the control group) within the 24-month timeframe of the trial. Interpretation: The REACT programme could be considered a cost-effective approach for improving the health-related quality of life of older adults at risk of mobility limitations. Funding: National Institute for Health Research Public Health Research Programme.

AB - Background: Mobility limitations in older populations have a substantial impact on health outcomes, quality of life, and social care costs. The Retirement in Action (REACT) randomised controlled trial assessed a 12-month community-based group physical activity and behaviour maintenance intervention to help prevent decline in physical functioning in older adults at increased risk of mobility limitation. We aimed to do an economic evaluation of the REACT trial to investigate whether the intervention is cost-effective. Methods: In this health economic evaluation, we did cost-effectiveness and cost-utility analyses of the REACT programme versus standard care on the basis of resource use, primary outcome, and health-related quality-of-life data measured in the REACT trial. We also developed a decision analytic Markov model that forecasts the mobility of recipients beyond the 24-month follow-up of the trial and translated this into future costs and potential benefit to health-related quality of life using the National Health Service and Personal Social Services perspective. Participants completed questionnaire booklets at baseline, and at 6, 12, and 24 months after randomisation, which included a resource use questionnaire and the EQ-5D-5L and 36-item short-form survey (SF-36) health-related quality-of-life instruments. The cost of delivering the intervention was estimated by identifying key resources, such as REACT session leader time, time of an individual to coordinate the programme, and venue hire. EQ-5D-5L and SF-36 responses were converted to preference-based utility values, which were used to estimate quality-adjusted life-years (QALYs) over the 24-month trial follow-up using the area-under-the-curve method. We used generalised linear models to examine the effect of the REACT programme on costs and QALYs and adjust for baseline covariates. Costs and QALYs beyond 12 months were discounted at 3·5% per year. This is a pre-planned analysis of the REACT trial; the trial itself is registered with ISRCTN (ISRCTN45627165). Findings: The 12-month REACT programme was estimated to cost £622 per recipient to deliver. The most substantial cost components are the REACT session leader time (£309 per participant), venue hire (£109), and the REACT coordinator time (£80). The base-case analysis of the trial-based economic evaluation showed that reductions in health and social care usage due to the REACT programme could offset the REACT delivery costs (£3943 in the intervention group vs £4043 in the control group; difference: –£103 [95% CI −£695 to £489]) with a health benefit of 0·04 QALYs (0·009–0·071; 1·354 QALYs in the intervention group vs 1·314 QALYs in the control group) within the 24-month timeframe of the trial. Interpretation: The REACT programme could be considered a cost-effective approach for improving the health-related quality of life of older adults at risk of mobility limitations. Funding: National Institute for Health Research Public Health Research Programme.

KW - Exercise

KW - State Medicine

KW - Cost-Benefit Analysis

KW - Humans

KW - Quality of Life

KW - Aged

KW - Retirement

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U2 - 10.1016/S2468-2667(22)00030-5

DO - 10.1016/S2468-2667(22)00030-5

M3 - Article

SN - 2468-2667

VL - 7

SP - e327-e334

JO - The Lancet Public Health

JF - The Lancet Public Health

IS - 4

ER -

Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

Fingerprint

Research output

Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: the REACT (REtirement in ACTion) randomised controlled trial

Hippocampal maintenance after a 12-month physical activity intervention in older adults: The REACT MRI study

The tribulations of trials: lessons learnt recruiting 777 older adults into REtirement in ACTion (REACT) a community, group-based active ageing intervention targeting mobility disability.

A community-based physical activity intervention to prevent mobility-related disability for retired older people (REtirement in ACTion [REACT]): study protocol for a randomised controlled trial

Cite this