Cost-effectiveness implications of GP intervention to promote physical activity: evidence from Perth, Australia

Amarasinghe Cost Effectiveness and Resource Allocation 2010, 8:10 http://www.resource-allocation.com/content/8/1/10 Open Access RESEARCH Cost-effectiveness implications of GP intervention to promote physical activity: evidence from Perth, Australia Research Anura K Amarasinghe Abstract Background: Physical inactivity is a major risk factor for many chronic diseases including diabetes, cardiovascular diseases and some cancers. It is estimated that, in Australia, physical inactivity contributes to 13,500 annual deaths and incurs an annual cost of AU$ 21 billion to the health care system. The cost of physical inactivity to the Western Australian (WA) economy is estimated to be about AU$ 2.1 billion. Increased burden of physical inactivity has motivated health professionals to seek cost effective intervention to promote physical activity. One such strategy is encouraging general practitioners (GPs) to advocate physical activity to the patients who are at high risk of developing chronic diseases associated with physical inactivity. This study intends to investigate the cost-effectiveness of a subsidy program for GP advice to promote physical activity. Methodology: The percentage of population that could potentially move from insufficiently active to sufficiently active, on GP advice was drawn from the Western Australian (WA) Premier's Physical Activity Taskforce (PATF) survey in 2006. Population impact fractions (PIF) for diseases attributable to physical inactivity together with disability adjusted life years (DALYs) and health care expenditure were used to estimate the net cost of intervention for varying subsidies. Cost-effectiveness of subsidy programs were evaluated in terms of cost per DALY saved at different compliance rates. Results: With a 50% adherence to GP advice, an annual health care cost of AU$ 24 million could be potentially saved to the WA economy. A DALY can be saved at a cost of AU $ 11,000 with a AU$ 25 subsidy at a 50% compliance rate. Cost effectiveness of such a subsidy program decreases at higher subsidy and lower compliance rates. Conclusion: Implementing a subsidy for GP advice could potentially reduce the burden of physical inactivity. However, the cost-effectiveness of a subsidy program for GP advice depends on the percentage of population who comply with GP advice. Introduction The World Health Organisation (WHO) identified physical inactivity as a major risk factor contributing to diseases such as ischemic heart disease, ischemic stroke, breast cancer, colon/rectum cancer and diabetes mellitus [1]. It was estimated that, in Australia, physical inactivity contributes to 13,500 annual deaths and incurs an annual cost of AU$ 21 billion to the health care system [2,3]. The cost of physical inactivity to the Western Australian (WA) economy was estimated to be about AU $ 2.1 billion [2]. Increasing physical activity could potentially save at least * Correspondence: 1 Centre for the Built Environment and Health, School of Population Health, The University of Western Australia, Australia 6.6% of total burden of diseases and injury in Australia [3]. In the UK, physical inactivity is directly responsible for 3% of disability adjusted life years lost and £1.06 billion direct health care cost to the National Health Service [4]. About CA$ 2.1 billion, or 2.5% of total direct health care costs in Canada, were attributable to physical inactivity in 1999 [5]. It was found that a 10% reduction in the prevalence of physical inactivity in Canada has the potential to reduce direct health care expenditure by CA$1,550 million per year [5]. In addition, in 1995, physical inactivity caused approximately 21,000 premature lives lost in Canada. Increased burden of physical inactivity around the world has motivated health professionals to seek cost Full list of author information is available at the end of the article © 2010 Amarasinghe; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons BioMed Central Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Amarasinghe Cost Effectiveness and Resource Allocation 2010, 8:10 http://www.resource-allocation.com/content/8/1/10 effective intervention to promote physical activity. One such strategy is encouraging general practitioners (GPs) to address health needs of patients who are at risk of developing chronic diseases associated with physical inactivity. One proposed Australian GP intervention aimed to tackle the obesity crisis and prevent chronic illnesses revealed that an overweight Australian could pocket a AU$ 170 subsidy by signing up for weight loss programs [6]. It was also indicated that the AU$ 200 cost of a 12-week weight loss program is currently beyond the reach of many people who could benefit from it. The Australian General Practice Network also wants AU$ 40 million to be spent on a national program to teach good parenting techniques [6]. Although a few attempts have been made to investigate the cost-effectiveness of physical activity intervention in primary care settings, all of them have a major drawback: the use of different health outcomes to assess health benefits [7-11]. Thus, results are difficult to compare across studies and programs. This may hinder or delay the implementation of the policies that may help promote physical inactivity in general. On the other hand, assessing cost-effectiveness in terms of common health outcomes may be more relevant for health advocates in allocating the limited healthcare budget available for prudent policy interventions. In the recent past, few attempts have been made towards this end in a cost-utility framework. The cost utility analysis of physical activity counselling in general practice in New Zealand shows that the cost per quality adjusted life years (QALY) gained over full life expectancy ranges from NZ$ 827 to NZ$ 37516 ($AU 680 to 31,000). This study suggests that it would be wise encouraging GPs to prescribe physical activity advice in primary care settings [12]. The Active Script Programme (ASP) in Victoria, Australia was designed to increase the number of general practitioners (GPs) who delivered appropriate, consistent, and effective physical activity advice to patients. ASP showed that, although the impact of the GP intervention was modest, the cost-effectiveness figures were impressive. A study showed that the program only cost AU$ 138 per patient to become sufficiently active to a level that gains health benefits and a DALY can be saved at a cost AU$ 3647 per year [13]. One of the limitations of this study is that the modelling framework is based on a hypothetical % of people who become active, rather than the actual impacts of intervention. However, this is the only known Australian costeffectiveness study which investigates the impacts of GP inte (...truncated)