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Randomized Controlled Trial
. 2015 Oct;49(20):1343-7.
doi: 10.1136/bjsports-2013-092743. Epub 2013 Nov 6.

Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia

Jennifer C Davis  1 , Stirling Bryan  2 , Carlo A Marra  3 , Ging-Yuek R Hsiung  4 , Teresa Liu-Ambrose  5
Affiliations
Randomized Controlled Trial

Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia

Jennifer C Davis et al. Br J Sports Med. 2015 Oct.

Abstract

Background: Cognitive decline is one of the most prominent healthcare issues of the 21st century. Within the context of combating cognitive decline through behavioural interventions, physical activity is a promising approach. There is a dearth of health economic data in the area of behavioural interventions for dementia prevention. Yet, economic evaluations are essential for providing information to policy makers for resource allocation. It is essential we first address population and intervention-specific methodological challenges prior to building a larger evidence base. We use a cost-utility analysis conducted alongside the exercise for cognition and everyday living (EXCEL) study to illustrate methodological challenges specific to assessing the cost-effectiveness of behavioural interventions aimed at older adults at risk of cognitive decline.

Methods: A cost-utility analysis conducted concurrently with a 6-month, three-arm randomised controlled trial (ie, the EXCEL study) was used as an example to identify and discuss methodological challenges.

Results: Both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. In critically evaluating the economic evaluation of the EXCEL study we identified four category-specific challenges: (1) analysing costs; (2) assessing quality-adjusted life-years; (3) Incomplete data; and (4) 'Intervention' activities of the control group.

Conclusions: Resistance training and aerobic training resulted in healthcare cost saving and were equally effective to balance and tone classes after only 6 months of intervention. To ensure this population is treated fairly in terms of claims on resources, we first need to identify areas for methodological improvement.

Keywords: Exercise; Physical activity and exercise methodology; Physical activity promotion in primary care; Walking; Weight lifting.

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Conflict of interest statement

Competing Interests: All authors have nothing to declare.

Conflict of Interest Statement

Jennifer C. Davis is funded by a Michael Smith Foundation for Health Research Senior Graduate Studentship, a Canadian Institute for Health Research Canada Graduate Scholarship. Teresa Liu-Ambrose is a Canada Research Chair in Physical Activity, Mobility, and Cognitive Neuroscience and a Michael Smith Foundation for Health Research (MSFHR) Scholar. Carlo A. Marra is funded by a Canada Research Chair in Pharmaceutical Outcomes and a Michael Smith Foundation for Health Research Scholar Award. G-Y. R. Hsiung is funded by a Canadian Institute of Health Research Clinical Genetics Investigatorship, and has received research support as a clinical trials site investigator from Baxter, Bristol-Myers-Squibb, Elan, Janssen-AI, Pfizer, Hoffman-La Roche, and Genentech.

Conflict of interest: None declared.

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