Cost-effectiveness of physical activity interventions in adolescents: model development and illustration using two exemplar interventions

BMJ Open. 2019 Aug 18;9(8):e027566. doi: 10.1136/bmjopen-2018-027566.


Objective: To develop a model to assess the long-term costs and health outcomes of physical activity interventions targeting adolescents.

Design: A Markov cohort simulation model was constructed with the intention of being capable of estimating long-term costs and health impacts of changes in activity levels during adolescence. The model parameters were informed by published literature and the analysis took a National Health Service perspective over a lifetime horizon. Univariate and probabilistic sensitivity analyses were undertaken.

Setting: School and community.

Participants: A hypothetical cohort of adolescents aged 16 years at baseline.

Interventions: Two exemplar school-based: a comparatively simple, after-school intervention and a more complex multicomponent intervention compared with usual care.

Primary and secondary outcome measures: Incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained.

Results: The model gave plausible estimates of the long-term effect of changes in physical activity. The use of two exemplar interventions suggests that the model could potentially be used to evaluate a number of different physical activity interventions in adolescents. The key model driver was the degree to which intervention effects were maintained over time.

Conclusions: The model developed here has the potential to assess long-term value for money of physical activity interventions in adolescents. The two applications of the model indicate that complex interventions may not necessarily be the ones considered the most cost-effective when longer-term costs and consequences are taken into account.

Keywords: cost-effectiveness; health economics; physical activity; young adult.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cost-Benefit Analysis
  • Exercise / physiology*
  • Female
  • Humans
  • Male
  • Markov Chains
  • Primary Health Care / economics*
  • Program Evaluation*
  • Quality of Life*
  • Schools*