28What is the effectiveness and cost-effectiveness of people at high risk of cardiovascular disease taking regular physical activity, versus sedentary lifestyle, to improve CHD/CVD mortality/morbidity outcomes?

No 727Study Quality:The cost-effectiveness of exercise training for the primary and secondary prevention of cardiovascular disease
Author:Lowensteyn I; Coupal L; Zowall H; Grover SA;2000
Relevance:Exercise vs no exercise
Intervention:Exercise training
Comparison:no exercise training
Population:35–74 year old Canadians who participated in the Canadian health survey 1992 with or without CHD
Perspective:Health service
Study type:Cost-effectiveness analysis, CHD events and years of life saved, costs
Methods:clinical trials published between 1980–1999
Health valuations:Not Applicable
Cost components:Direct medical costs as per Quebec and Ontario insurance plans
Currency:Canadian $
Cost year:1996
Time horizon:lifetime
Discount rate:3%
Results cost:Non supervised exercise:$13,416.97
No exercise:$13,234.27
Results effectiveness:The authors reported results for the 35–64 year age group only. The years of life saved were 0.70. They reported that less years of life saved were seen in the elderly and women
Results incremental:100% adherernceMen nonmen supervisedwomen nonwomen supervised
assuming 50% adherence in the first year and 30% in subsequent years
Results Uncertainty:The model remained robust in sensitivity analysis except for the assumption on adherence when less patients were assumed not to adhere to the programme, exercise was no longer cost-effective especially in women supervised programme. However in men the programme remained cost-effective.
Source Funding:Private
Comments:A good paper overall, but did not report effectiveness results separatetly for different age groups
No 726Study Quality:A cost-effectiveness analysis of exercise as a health promotion activity
Author:Hatziandreu EI; Koplan JP; Weinstein MC; Caspersen CJ; Warner KE;1988
Relevance:exercise versus no exercise
Comparison:no exercise
Population:35 year olds with CHD/CVD followed for 30 years for the coccurance of CDH events
Study type:cost utility analysis, life years gained, costs, QALYs, CHD events
Methods:epidemiological data from the Framingham studies
Health valuations:NOT STATED
Cost components:direct and indirect medical costs i.e. follow up costs, equipment costs, work time losts
Cost year:not clear but authors used 1985 wages
Time horizon:30 years
Discount rate:3%
Results cost:Exercisers $3.132 million

Non-exercisers $2.39m

N.B. I have taken only direct costs and excluded indirect costs which are not relevant to the health service
Results effectiveness:Years of life lost
Non exercisers1270.3 yrs
this translates to 529.8 discounted QALYs
Results incremental:Cost/QALY gained

Results Uncertainty:A range of univariate sensitivity analysis was done, varying the discount rate, relative risk of CHD for non exercisers, prevalence rate of exercise, doubling the direct cost of exercise and did not alter the base case conclusions. The model was robust to all changes in assumptions that were tested.
Source Funding:not stated
Comments:This study is old, but however it used appropriate methodology. Unit costs were not provided separately and sources of the utility data not described in the paper.

From: Appendix E, Health Economic Extractions

Cover of Lipid Modification
Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease [Internet].
NICE Clinical Guidelines, No. 67.
National Collaborating Centre for Primary Care (UK).
Copyright © 2008, Royal College of General Practitioners.

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