Health economic evaluation of controlled and maintained physical exercise in the prevention of cardiovascular and other prosperity diseases

Objectives Several studies and reports support the health benefits of frequent physical exercise, on the condition that this exercise is controlled and maintained. Given the scarce resources that can be spent on health and health care, the objective of this study was to evaluate the long-term health and economic outcomes of controlled and maintained physical exercise in a fitness setting. Methods A 25-year Markov model with a 12-month cycle-length and states representing diabetes, coronary heart disease, stroke, colon cancer and breast cancer was developed to predict cumulative costs and QALYs (quality adjusted life years) for three defined population cohorts, of different risk levels. Physical exercise was thereby compared with no intervention. Reduced risks associated with physical exercise, cost of diseases and loss of quality of life in case of disease were obtained from published literature. Costs were taken from a societal perspective; Belgium was selected as the setting. One way and probabilistic sensitivity analyses were carried out. Results For each of the cohorts, physical exercise is predicted to increase the QALYs and to offset a large part of the initial investment. The cost per QALY varies from E2000 to 15 000 per QALY depending on the risk levels, which is better compared with a majority of secondary preventions that are currently publicly financed. Conclusion Controlled and maintained physical exercise is projected to be cost-effective, which is likely to be explained by its simultaneous effect on several diseases and the associated weight loss, which affects quality of life positively. EurJ Cardiovasc Prev Rehabil 14:815-824 (c) 2007.