Five-year cost-effectiveness analysis of the European Fans in Training (EuroFIT) physical activity intervention for men versus no intervention

• Published in: The international journal of behavioral nutrition and physical activity Vol. 17; no. 1; p. 30
• Main Authors: Kolovos, Spyros, Finch, Aureliano P, van der Ploeg, Hidde P, van Nassau, Femke, Broulikova, Hana M, Baka, Agni, Treweek, Shaun, Gray, Cindy M, Jelsma, Judith G M, Bunn, Christopher, Roberts, Glyn C, Silva, Marlene N, Gill, Jason M R, Røynesdal, Øystein, van Mechelen, Willem, Andersen, Eivind, Hunt, Kate, Wyke, Sally, Bosmans, Judith E
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04-03-2020; BioMed Central; BMC
• Subjects: Analysis; Blood pressure; Body mass index; Cancer; Cancer research; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Chronic diseases; Colorectal cancer; Coronary heart disease; Cost analysis; Cost benefit analysis; Demographic aspects; Diabetes; Diabetes Mellitus, Type 2; Diseases; Economic aspects; Epidemiology; Europe; Exercise; Exercise - physiology; Exercise therapy; Health care costs; Heart diseases; Humans; Information retrieval; Intervention; Male; Medical economics; Men's health; Mental depression; Methods; Monte Carlo methods; Mortality; Physical Conditioning, Human - economics; Physical Conditioning, Human - statistics & numerical data; Physical fitness; Prevention; Professional football; Public health; Public health movements; Quality-Adjusted Life Years; Retirement benefits; Risk factors; Soccer; Sports - economics; Sports - statistics & numerical data; Sports spectators; Time; Type 2 diabetes; Europe; England; Netherlands; United Kingdom > UK; Norway; Portugal
• ISSN: 1479-5868; 1479-5868
• DOI: 10.1186/s12966-020-00934-7

Increasing physical activity reduces the risk of chronic illness including Type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle interventions can increase physical activity but few successfully engage men. This study aims to investigate the 5 year cost-effectiveness of EuroFIT, a program to improve physical activity tailored specifically for male football (soccer) fans compared to a no intervention comparison group.
We developed a Markov cohort model in which the impact of improving physical activity on five chronic health conditions (colorectal cancer, Type 2 diabetes, coronary heart disease, stroke and depression) and mortality was modelled. We estimated costs from a societal perspective and expressed benefits as quality adjusted life years (QALYs). We obtained data from a 4-country (England, Netherlands, Portugal and Norway) pragmatic randomised controlled trial evaluating EuroFIT, epidemiological and cohort studies, and meta-analyses. We performed deterministic and probabilistic sensitivity analyses to assess the impact of uncertainty in the model's parameter values on the cost-effectiveness results. We used Monte Carlo simulations to estimate uncertainty and presented this using cost-effectiveness acceptability curves (CEACs). We tested the robustness of the base case analysis using five scenario analyses.
Average costs over 5 years per person receiving EuroFIT were €14,663 and per person receiving no intervention €14,598. Mean QALYs over 5 years were 4.05 per person for EuroFIT and 4.04 for no intervention. Thus, the average incremental cost per person receiving EuroFIT was €65 compared to no intervention, while the average QALY gain was 0.01. This resulted in an ICER of €5206 per QALY gained. CEACs show that the probability of EuroFIT being cost-effective compared to no intervention is 0.53, 0.56 and 0.58 at thresholds of €10,000, €22,000 and €34,000 per QALY gained, respectively. When using a time horizon of 10 years, the results suggest that EuroFIT is more effective and less expensive compared to (i.e. dominant over) no intervention with a probability of cost-effectiveness of 0.63 at a threshold of €22,000 per QALY gained.
We conclude the EuroFIT intervention is not cost-effective compared to no intervention over a period of 5 years from a societal perspective, but is more effective and less expensive (i.e. dominant) after 10 years. We thus suggest that EuroFIT can potentially improve public health in a cost-effective manner in the long term.