The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation

T. G. Pavey, N. Anokye, A.H. Taylor, P. Trueman, T. Moxham, K. R. Fox, M. Hillsdon, C. Green, J. L. Campbell, C. Foster, Nanette Mutrie, J. Searle, R.S. Taylor

Research output: Contribution to journalArticle

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Abstract

Exercise referral schemes (ERS) aim to identify inactive adults in the primary-care setting. The GP or health-care professional then refers the patient to a third-party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the individual. To assess the clinical effectiveness and cost-effectiveness of ERS for people with a diagnosed medical condition known to benefit from physical activity (PA). The scope of this report was broadened to consider individuals without a diagnosed condition who are sedentary. Data sources: MEDLINE; EMBASE; PsycINFO; The Cochrane Library, ISI Web of Science; SPORTDiscus and ongoing trial registries were searched (from 1990 to October 2009) and included study references were checked. Systematic reviews: the effectiveness of ERS, predictors of ERS uptake and adherence, and the cost-effectiveness of ERS; and the development of a decision-analytic economic model to assess cost-effectiveness of ERS. Seven randomised controlled trials (UK, n=5; non-UK, n=2) met the effectiveness inclusion criteria, five comparing ERS with usual care, two compared ERS with an alternative PA intervention, and one to an ERS plus a self-determination theory (SDT) intervention. In intention-to-treat analysis, compared with usual care, there was weak evidence of an increase in the number of ERS participants who achieved a self-reported 90-150 minutes of at least moderate-intensity PA per week at 6-12 months' follow-up [pooled relative risk (RR) 1.11, 95% confidence interval 0.99 to 1.25]. There was no consistent evidence of a difference between ERS and usual care in the duration of moderate/vigorous intensity and total PA or other outcomes, for example physical fitness, serum lipids, health-related quality of life (HRQoL). There was no between-group difference in outcomes between ERS and alternative PA interventions or ERS plus a SDT intervention. None of the included trials separately reported outcomes in individuals with medical diagnoses. Fourteen observational studies and five randomised controlled trials provided a numerical assessment of ERS uptake and adherence (UK, n=16; non-UK, n=3). Women and older people were more likely to take up ERS but women, when compared with men, were less likely to adhere. The four previous economic evaluations identified suggest ERS to be a cost-effective intervention. Indicative incremental cost per quality-adjusted life-year (QALY) estimates for ERS for various scenarios were based on a de novo model-based economic evaluation. Compared with usual care, the mean incremental cost for ERS was 169 and the mean incremental QALY was 0.008, with the base-case incremental cost-effectiveness ratio at 20,876 per QALY in sedentary people without a medical condition and a cost per QALY of 14,618 in sedentary obese individuals, 12,834 in sedentary hypertensive patients, and 8414 for sedentary individuals with depression. Estimates of cost-effectiveness were highly sensitive to plausible variations in the RR for change in PA and cost of ERS. We found very limited evidence of the effectiveness of ERS. The estimates of the cost-effectiveness of ERS are based on a simple analytical framework. The economic evaluation reports small differences in costs and effects, and findings highlight the wide range of uncertainty associated with the estimates of effectiveness and the impact of effectiveness on HRQoL. No data were identified as part of the effectiveness review to allow for adjustment of the effect of ERS in different populations. There remains considerable uncertainty as to the effectiveness of ERS for increasing activity, fitness or health indicators or whether they are an efficient use of resources in sedentary people without a medical diagnosis. We failed to identify any trial-based evidence of the effectiveness of ERS in those with a medical diagnosis. Future work should include randomised controlled trials assessing the cinical effectiveness and cost-effectivenesss of ERS in disease groups that may benefit from PA.

LanguageEnglish
Pages1–254
Number of pages254
JournalHealth Technology Assessment
Volume15
Issue number44
DOIs
Publication statusPublished - Dec 2011

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Cost-Benefit Analysis
Referral and Consultation
Exercise
Quality-Adjusted Life Years
Costs and Cost Analysis
Personal Autonomy
Randomized Controlled Trials
Uncertainty

Keywords

  • Exercise referral schemes
  • exercise programme
  • physical activity

Cite this

Pavey, T. G., Anokye, N., Taylor, A. H., Trueman, P., Moxham, T., Fox, K. R., ... Taylor, R. S. (2011). The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technology Assessment, 15(44), 1–254. https://doi.org/10.3310/hta15440
Pavey, T. G. ; Anokye, N. ; Taylor, A.H. ; Trueman, P. ; Moxham, T. ; Fox, K. R. ; Hillsdon, M. ; Green, C. ; Campbell, J. L. ; Foster, C. ; Mutrie, Nanette ; Searle, J. ; Taylor, R.S. / The clinical effectiveness and cost-effectiveness of exercise referral schemes : a systematic review and economic evaluation. In: Health Technology Assessment. 2011 ; Vol. 15, No. 44. pp. 1–254.
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Pavey, TG, Anokye, N, Taylor, AH, Trueman, P, Moxham, T, Fox, KR, Hillsdon, M, Green, C, Campbell, JL, Foster, C, Mutrie, N, Searle, J & Taylor, RS 2011, 'The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation' Health Technology Assessment, vol. 15, no. 44, pp. 1–254. https://doi.org/10.3310/hta15440

The clinical effectiveness and cost-effectiveness of exercise referral schemes : a systematic review and economic evaluation. / Pavey, T. G.; Anokye, N.; Taylor, A.H.; Trueman, P.; Moxham, T.; Fox, K. R.; Hillsdon, M.; Green, C.; Campbell, J. L.; Foster, C.; Mutrie, Nanette; Searle, J.; Taylor, R.S.

In: Health Technology Assessment, Vol. 15, No. 44, 12.2011, p. 1–254.

Research output: Contribution to journalArticle

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AU - Pavey, T. G.

AU - Anokye, N.

AU - Taylor, A.H.

AU - Trueman, P.

AU - Moxham, T.

AU - Fox, K. R.

AU - Hillsdon, M.

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