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Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial.
BMJ Open. 2017 03 29; 7(3):e014387.BO

Abstract

BACKGROUND/OBJECTIVES

Evidence suggests that aerobic exercise may slow the progression of subcortical ischaemic vascular cognitive impairment (SIVCI) by modifying cardiovascular risk factors. Yet the economic consequences relating to aerobic training (AT) remain unknown. Therefore, our primary objective was to estimate the incremental cost per quality-adjusted life years (QALYs) gained of a thrice weekly AT intervention compared with usual care.

DESIGN

Cost-utility analysis alongside a randomised trial.

SETTING

Vancouver, British Columbia, Canada.

PARTICIPANTS

70 adults (mean age of 74 years, 51% women) who meet the diagnostic criteria for mild SIVCI.

INTERVENTION

A 6-month, thrice weekly, progressive aerobic exercise training programme compared with usual care (CON; comparator) with a follow-up assessment 6 months after formal cessation of aerobic exercise training.

MEASUREMENTS

Healthcare resource usage was estimated over the 6-month intervention and 6-month follow-up period. Health status (using the EQ-5D-3L) at baseline and trial completion and 6-month follow-up was used to calculate QALYs. The incremental cost-utility ratio (cost per QALY gained) was calculated.

RESULTS

QALYs were both modestly greater, indicating a health gain. Total healthcare costs (ie, 1791±1369 {2015 $CAD} at 6 months) were greater, indicating a greater cost for the thrice weekly AT group compared with CON. From the Canadian healthcare system perspective, the incremental cost-utility ratios for thrice weekly AT were cost-effective compared with CON, when using a willingness to pay threshold of $CAD 20 000 per QALY gained or higher.

CONCLUSIONS

AT represents an attractive and potentially cost-effective strategy for older adults with mild SIVCI.

TRIAL REGISTRATION NUMBER

NCT01027858.

Links

PMC Free PDF

Authors+Show Affiliations

Davis JC
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada.
Hsiung GR
Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
Bryan S
Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, British Columbia, Canada.
Best JR
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada.
Eng JJ
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
Munkacsy M
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada.
Cheung W
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada.
Chiu B
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada.
Jacova C
Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
Lee P
Department of Medicine, Division of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Liu-Ambrose T
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada.

MeSH

AgedCanadaCognitive DysfunctionCost-Benefit AnalysisExerciseExercise TherapyFemaleHealth ResourcesHumansMaleOutcome Assessment, Health CareQuality-Adjusted Life YearsVascular Diseases

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28360247

Clinical Trial Links

Clinical trial which this article describes

Citation

Davis, Jennifer C., et al. "Economic Evaluation of Aerobic Exercise Training in Older Adults With Vascular Cognitive Impairment: PROMoTE Trial." BMJ Open, vol. 7, no. 3, 2017, pp. e014387.
Davis JC, Hsiung GR, Bryan S, et al. Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial. BMJ Open. 2017;7(3):e014387.
Davis, J. C., Hsiung, G. R., Bryan, S., Best, J. R., Eng, J. J., Munkacsy, M., Cheung, W., Chiu, B., Jacova, C., Lee, P., & Liu-Ambrose, T. (2017). Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial. BMJ Open, 7(3), e014387. https://doi.org/10.1136/bmjopen-2016-014387
Davis JC, et al. Economic Evaluation of Aerobic Exercise Training in Older Adults With Vascular Cognitive Impairment: PROMoTE Trial. BMJ Open. 2017 03 29;7(3):e014387. PubMed PMID: 28360247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial. AU - Davis,Jennifer C, AU - Hsiung,Ging-Yuek Robin, AU - Bryan,Stirling, AU - Best,John R, AU - Eng,Janice J, AU - Munkacsy,Michelle, AU - Cheung,Winnie, AU - Chiu,Bryan, AU - Jacova,Claudia, AU - Lee,Philip, AU - Liu-Ambrose,Teresa, Y1 - 2017/03/29/ PY - 2017/4/1/entrez PY - 2017/4/1/pubmed PY - 2017/12/19/medline KW - aerobic training KW - cost-utility analysis KW - economic evaluation KW - exercise KW - mild cognitive impairment KW - older adults SP - e014387 EP - e014387 JF - BMJ open JO - BMJ Open VL - 7 IS - 3 N2 - BACKGROUND/OBJECTIVES: Evidence suggests that aerobic exercise may slow the progression of subcortical ischaemic vascular cognitive impairment (SIVCI) by modifying cardiovascular risk factors. Yet the economic consequences relating to aerobic training (AT) remain unknown. Therefore, our primary objective was to estimate the incremental cost per quality-adjusted life years (QALYs) gained of a thrice weekly AT intervention compared with usual care. DESIGN: Cost-utility analysis alongside a randomised trial. SETTING: Vancouver, British Columbia, Canada. PARTICIPANTS: 70 adults (mean age of 74 years, 51% women) who meet the diagnostic criteria for mild SIVCI. INTERVENTION: A 6-month, thrice weekly, progressive aerobic exercise training programme compared with usual care (CON; comparator) with a follow-up assessment 6 months after formal cessation of aerobic exercise training. MEASUREMENTS: Healthcare resource usage was estimated over the 6-month intervention and 6-month follow-up period. Health status (using the EQ-5D-3L) at baseline and trial completion and 6-month follow-up was used to calculate QALYs. The incremental cost-utility ratio (cost per QALY gained) was calculated. RESULTS: QALYs were both modestly greater, indicating a health gain. Total healthcare costs (ie, 1791±1369 {2015 $CAD} at 6 months) were greater, indicating a greater cost for the thrice weekly AT group compared with CON. From the Canadian healthcare system perspective, the incremental cost-utility ratios for thrice weekly AT were cost-effective compared with CON, when using a willingness to pay threshold of $CAD 20 000 per QALY gained or higher. CONCLUSIONS: AT represents an attractive and potentially cost-effective strategy for older adults with mild SIVCI. TRIAL REGISTRATION NUMBER: NCT01027858. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/28360247/Economic_evaluation_of_aerobic_exercise_training_in_older_adults_with_vascular_cognitive_impairment:_PROMoTE_trial_ DB - PRIME DP - Unbound Medicine ER -