Systematic review of the methods used in economic evaluations of targeted physical activity and sedentary behaviour interventions

Abstract

The burden of noncommunicable diseases (NCD) on health systems worldwide is substantial. Physical inactivity and sedentary behaviour are major risk factors for NCD.Previous attempts to understand the value for money of preventative interventions targeting physically inactive individuals have proved to be challenging due to key methodological challenges associated with the conduct of economic evaluations in public health. A systematic review was carried out across six databases (Medline, SPORTSDiscus, EconLit, PsychINFO, NHS EED, HTA) along with supplementary searches. The review examines how economic evaluations published between 2009-March 2017 have addressed methodological challenges with the aim of bringing to light examples of good practice for future studies. Fifteen economic evaluations from four high-income countries were retrieved; there is a dearth of studies targeting sedentary behaviour as an independent risk factor from physical activity. Comparability of studies from the healthcare and societal perspectives were limited due to analysts' choice in cost categories, valuation technique and time horizon 2 differing substantially. The scarcity of and inconsistencies across economic evaluations for these two behaviours have exposed a mismatch between calls for more preventative action to tackle NCD and the lack of information available on how resources may be optimally allocated in practice. Consequently, this paper offers a table of recommendations on how future studies can be improved.

Methodological issues in economic evaluations of disease prevention and health promotion: an overview of systematic and scoping reviews

“…The inclusion criteria assessment resulted in ten systematic and one empirical (scoping) review (Fig. 1 ) [ 5 , 19 , 23 – 31 ] Excluded reviews are shown in Additional file 4 . Of the included reviews (Table 1 ), five addressed different preventive measures for older people [ 25 , 27 ] or children/adolescents [ 26 , 28 , 30 ], while the others targeted physical activity [ 23 ], implementation of DPHP [ 24 ], alcohol prevention [ 31 ], behavior change [ 5 ], injury prevention [ 29 ], or different areas of prevention [ 19 ].…”

“…1 ) [ 5 , 19 , 23 – 31 ] Excluded reviews are shown in Additional file 4 . Of the included reviews (Table 1 ), five addressed different preventive measures for older people [ 25 , 27 ] or children/adolescents [ 26 , 28 , 30 ], while the others targeted physical activity [ 23 ], implementation of DPHP [ 24 ], alcohol prevention [ 31 ], behavior change [ 5 ], injury prevention [ 29 ], or different areas of prevention [ 19 ]. Overall, these reviews included 494 economic analyses (CEA: 42%, CUA: 20%, different types of economic study: 16%, CCA: 15%, CBA: 6%, CMA: 1%.…”

Modelling the impact of physical activity on public health: A review and critique

“…Complementary to previous reviews [8][9][10][11]14 , this is the first methodological review to provide an overview and critique of the modelling approaches used in model-based economic evaluations for estimating impacts of changes in PA on public health. This review has shed light on key structural assumptions that underlie the models, which can aid interpretation of the cost-effectiveness findings and highlights model development opportunities.…”

“…Several studies have reviewed the cost-effectiveness evidence for promoting physical activity (PA) in the general population and found the interventions to provide value for money in most cases [3][4][5][6][7] . However, methodological reviews have highlighted a number of challenges related to the economic evaluation of public health interventions, including PA [8][9][10][11] . Covering all elements of the evaluation, from research design of the intervention to the statistical and economic analyses, these challenges have previously been grouped into four broad categories: attribution of effects, measuring and valuing outcomes, intersectoral costs and consequences and incorporating equity concerns.…”

“…A recent review examined how the four methodological challenges above have been addressed in applied studies, across two categories of PA interventions (targeted PA and sedentary behaviour) 11 . Confirming previous findings [8][9][10] , this review found an overall poor quality of reporting and marked inconsistencies in the methods applied across economic evaluations, providing a series of recommendations for the design, analysis and appraisal of economic evaluations.…”