Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial

Question: What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program? Design: A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon. Participants: People with chronic health conditions who had completed a 6-week exercise program at a community health service. Interventions: One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks. Outcome measures: Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L). Results: Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1 year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach. Conclusion: The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently. Crown Copyright (c) 2017 Published by Elsevier B.V. on behalf of Australian Physiotherapy Association.