Cost-effectiveness of physical activity interventions: Analysis from a systematic review

Background: Cost-effectiveness (CE) analysis can help decision makers maximize the use of scarce resources available to promote physical activity (PA). We developed a method to translate PA outcomes into a common measure of effectiveness and estimated intervention costs in order to compare CE across a wide variety of PA intervention strategies.

Methods: A systematic literature review was conducted that identified 92 interventions from 5579 articles for CE analysis. CE ratios were calculated as cost per unit of metabolic equivalent (MET) hour gained per day per individual reached. PA benefits were compared to US guideline recommended levels (1.5 MET hours per day for adults and 3.0 for school-age children).

Results: The most cost-effective strategy was point of decision prompts (e.g. signs to prompt stair use), with a median of $0.07/MET-hour/day/person, because of its low cost and large population reached. However, the benefit is limited to only meeting 0.2% of guideline recommended PA levels. School-based PA interventions targeted at children and adolescents (e.g. PA education, promotion of out-of-school PA) were relatively cost-effective (median $0.33/MET-hour/day/person) when no additional school staff's labor costs were required. These interventions generated an average 18% guideline recommended PA. Even the least cost-effective interventions – high intensity individually-adapted behavior change and social support programs – have low CE ratios (median $0.90- and $1.16/MET-hour/day/person, respectively), and, on average, generated more than 30% guideline recommended PA.

Conclusions: The analysis found many PA interventions cost-effective (CE ratios less than $1/MET-hour/day/person) and generated activities that significantly enhanced meeting recommended PA guidelines.