Cost-effectiveness of telephone coaching for physically inactive ambulatory care hospital patients: economic evaluation alongside the Healthy4U randomised controlled trial

BMJ Open. 2019 Dec 10;9(12):e032500. doi: 10.1136/bmjopen-2019-032500.


Objective: To assess whether telephone coaching is a cost-effective method for increasing physical activity and health-related quality of life for insufficiently active adults presenting to an ambulatory care clinic in a public hospital.

Design: An economic evaluation was performed alongside a randomised controlled trial.

Setting: Participants were recruited from an ambulatory care clinic in a public hospital in regional Australia.

Participants: Seventy-two adults (aged 18-69) deemed insufficiently physically active via self-report.

Interventions: Participants were randomised to either an intervention group that received an education session and eight sessions of telephone coaching over a 12-week period, or to a control group that received the education session only. The intervention used in the telephone coaching was integrated motivational interviewing and cognitive behavioural therapy.

Outcome measures: The primary health outcome was change in moderate-to-vigorous physical activity (MVPA), objectively measured via accelerometry. The secondary outcome was the quality-adjusted life-year (QALY) determined by the 12-item Short Form Health Survey Questionnaire. Outcome data were measured at baseline, postintervention (3 months) and follow-up (6 months). Incremental cost-effectiveness ratios (ICERs) were calculated for each outcome. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty.

Results: The mean intervention cost was $279±$13 per person. At 6 months follow-up, relative to control, the intervention group undertook 18 more minutes of daily MVPA at an ICER of $15/min for each additional minute of MVPA. With regard to QALYs, the intervention yielded an ICER of $36 857 per QALY gained. Sensitivity analyses indicated that results were robust to varied assumptions.

Conclusion: Telephone coaching was a low-cost strategy for increasing MVPA and QALYs in insufficiently physically active ambulatory care hospital patients. Additional research could explore the potential economic impact of the intervention from a broader healthcare perspective.

Trial registration number: ANZCTR: ACTRN12616001331426.

Keywords: health economics; preventive medicine; public health.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Accelerometry / methods
  • Ambulatory Care Facilities
  • Cost-Benefit Analysis
  • Disabled Persons* / education
  • Disabled Persons* / psychology
  • Female
  • Humans
  • Male
  • Mentoring / methods*
  • Middle Aged
  • Motivational Interviewing / methods
  • Outcome Assessment, Health Care / methods
  • Patient Education as Topic / methods*
  • Preventive Health Services / methods*
  • Quality of Life*
  • Sedentary Behavior
  • Surveys and Questionnaires
  • Telemedicine / methods*

Associated data

  • ANZCTR/ACTRN12616001331426