Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes: an economic evaluation of the 48-month PROPELS randomized controlled trial

Laura Ellen Heathcote, Daniel J. Pollard, Alan Brennan, Melanie J. Davies, Helen Eborall, Charlotte L. Edwardson, Michael Gillett, Laura J. Gray, Simon J. Griffin, Wendy Hardeman, Joseph Henson, Kamlesh Khunti, Stephen Sharp, Stephen Sutton, Thomas Yates

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Introduction: Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D.

Materials and methods: We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence’s willingness-to-pay of £20 000–£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective.

Results: Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years.

Conclusions: We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect.

Trial Registration number: ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structured Education with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)
Original languageEnglish
Article numbere003516
JournalBMJ Open Diabetes Research and Care
Issue number2
Publication statusPublished - 12 Mar 2024

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