Potential Transferability of Economic Evaluations of Programs Encouraging Physical Activity in Children and Adolescents across Different Countries—A Systematic Review of the Literature

Abstract

Physical inactivity is an increasing problem. Owing to limited financial resources, one method of getting information on the cost-effectiveness of different types of prevention programs is to examine existing programs and their results. The aim of this paper is to give an overview of the transferability of cost-effectiveness results of physical activity programs for children and adolescents to other contexts. Based on a systematic review of the literature, the transferability of the studies found was assessed using a sub-checklist of the European Network of Health Economic Evaluation Databases (EURONHEED). Thirteen studies of different physical activity interventions were found and analyzed. The results for transferability ranged from “low” to “very high”. A number of different factors influence a program’s cost-effectiveness (i.e., discount rate, time horizon, etc.). Therefore, transparency with regard to these factors is one fundamental element in the transferability of the results. A major point of criticism is that transferability is often limited because of lack of transparency. This paper is the first to provide both an overview and an assessment of transferability of economic evaluations of existing programs encouraging physical activity in children and adolescents. This allows decision makers to gain an impression on whether the findings are transferable to their decision contexts, which may lead to time and cost savings.

1. Introduction

“…6 Approximately 40% of all cancers and three-quarters World Health Organization, 10 Facts on Non-communicable Diseases, 2019, https:// www.who.int/features/factfiles/noncommunicable_diseases/facts/en/index4.html of the incidence of heart disease, stroke and type 2 diabetes could be prevented by addressing tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. A great deal of technical knowledge exists about how to prevent and manage NCDs, such as the WHO Package of Essential NCD interventions (WHO PEN), 7 the SHAKE 8 (the technical package for salt reduction) and HEARTS 9 (the technical package for cardiovascular disease management in primary health care) packages. In addition to the NCD burden, 10 there is an increasing demand on governments to address the health needs arising from NCDs through universal health coverage (UHC) policies, a direction that has been endorsed by the World Health Assembly 11 and the United Nations General Assembly.…”

“…This is because the authors believe that together evidence and process can be impactful, generating a loop of better evidence for better processes and vice versa, which eventually leads to better decisions with a greater impact on health. 9…”

“…To give an example of how local context can affect the impact and reach of an intervention, bike-sharing schemes, although not listed as a WHO Best Buy, are now popular in many countries, as they can encourage active commuting, hence physical activity, 9 as well as reducing congestion and potentially improving air quality. In Tehran, such a bike-sharing scheme is thriving, but only for men and not for women, due to the cultural and religious contexts that prevent women from taking part in the scheme.…”

“…Several case studies have also been conducted to assess transferability empirically, for example, in physical activities among children, breast cancer treatment and smoking cessation. 9 Despite the substantial growth of studies on this topic, systematic literature reviews and national guidelines have highlighted variations in approaches regarding the transferability of data from one setting to another. 10 Here, we briefly summarize the contributions of major papers identified through Google Scholar, PubMed and cited references.…”

“…8 The United Nations Development Programme (UNDP), in collaboration with WHO, has also developed briefs on how multiple sectors can engage in the prevention of NCDs. 9 Yet, NCDs receive less than 2% of all health funding globally, 10 and less than 1% in LMICs. 11 Additionally, as we explore in this chapter and has been shown in the Caribbean region, 12 has been concentrated on ensuring political commitment, as opposed to implementation activities.…”