Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial

Authors

  • Patricia A. Cowper PhD,

    Corresponding author
    1. Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
    2. Department of Medicine, Duke University Medical Center, Durham, North Carolina
    • Address correspondence to Patricia A. Cowper, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail: patricia.cowper@dm.duke.edu

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  • Matthew J. Peterson PhD,

    1. Departments of Community Health and Geriatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
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  • Carl F. Pieper DrPH,

    1. Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
    2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
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  • Richard J. Sloane MPH,

    1. Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
    2. School of Nursing, Duke University Medical Center, Durham, North Carolina
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  • Katherine S. Hall PhD,

    1. Department of Medicine, Duke University Medical Center, Durham, North Carolina
    2. Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
    3. Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
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  • Eleanor S. McConnell PhD,

    1. Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
    2. School of Nursing, Duke University Medical Center, Durham, North Carolina
    3. Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
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  • Hayden B. Bosworth PhD,

    1. Department of Medicine, Duke University Medical Center, Durham, North Carolina
    2. Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
    3. School of Nursing, Duke University Medical Center, Durham, North Carolina
    4. Health Services Research and Development Service, VA Medical Center, Durham, NC
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  • Carola C. Ekelund PT,

    1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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  • Megan P. Pearson MA,

    1. Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
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  • Miriam C. Morey PhD

    1. Department of Medicine, Duke University Medical Center, Durham, North Carolina
    2. Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
    3. Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
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Abstract

Objectives

To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans.

Design

Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance, physical activity, function, disability, and medical resource use and cost.

Setting

Veterans Affairs Medical Center, Durham, North Carolina.

Participants

Male veterans aged ≥70 years (n = 398).

Intervention

An experienced health counselor provided baseline in-person exercise counseling, followed by telephone counseling at 2, 4, and 6 weeks, and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention, followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly.

Measurements

Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated.

Results

The total direct cost of the intervention per participant was $459, 85% of which was counselor effort. With overhead, program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention, versus $12,052 with usual care (difference = −$1,634 (95% confidence interval = −$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes, the intervention cost $4,971 per additional patient reaching target exercise levels, or $4,640 per patient achieving a clinically significant change in rapid gait speed.

Conclusion

Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.

Ancillary