This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

The study investigated a group-based multi-component physical activity programme (PAP) to prevent physical impairment in elderly people. The PAP included a weekly training session that lasted 1.5 hours and continued over 5 months. The session consisted of 20 - 30 minutes of warming up, 35 - 40 minutes of strengthening and aerobic exercises, 15 - 20 minutes of games, stimulation of various senses, and 10 - 15 minutes of stretching.

Other: Physical activity.

Cost-effectiveness analysis.

The study population comprised individuals aged 65 years or older, who were living in Frederiksborg County, Denmark. The participants had to arrange their own transport to the training facilities.

The setting was the community. The economic study was carried out in Frederiksborg County, Denmark.

The date for the effectiveness evidence was 2002. The resource use data were collected in the 5 months before and 5 months after the intervention. The price year was 2002.

The effectiveness data were derived from a single study.

The costing was performed retrospectively on the same sample as that used in the effectiveness study.

Power calculations were not reported. Two hundred and forty-three individuals responded to the invitation to the PAP before the pre-test. This number reduced to 192 after the pre-test: 51 participants dropped out as they no longer wished to be tested. The final number of participants was 185, of which 138 were women. The mean age was 74.4 years (range: 65 to 87). The reason for this further decrease from 192 to 185 participants was not clear from the paper.

This was a pre-post (within group) study carried out in 15 municipalities in Frederiksborg County, Denmark. The length of follow-up was 5 months. The outcomes were measured at baseline and after 5 months of exercise.

It appears that the analysis was conducted on the basis of treatment completers only. The primary health outcomes and measures used in the analysis were:

height,

body weight,

body mass index (BMI),

handgrip, reaction time,

five chair-stand time,

maximal walking speed over 10 m,

physical performance test (PPT) score, and

Mobility-Tiredness Scale (Mob-T) score.

For men, the results (standard deviation, SD, in parentheses) of physical parameters and functional ability before and after the intervention were as follows:

height, 1.70 (0.05) m and 1.70 (0.05) m,

body weight, 76.0 (7.9) kg and 76.8 (8.1) kg,

BMI, 26.2 (2.3) kg/m2 and 26.4 (2.3) kg/m2,

handgrip, 34.0 (6.3) kg and 33.7 (6.3) kg,

reaction time, 0.23 (0.05) seconds and 0.21 (0.03) seconds,

five chair-stand time, 13.4 (3.4) seconds and 13.1 (4.0) seconds,

maximal walking speed over 10 m, 1.6 (0.3) m/second and 1.6 (0.3) m/second,

PPT score, 21.4 (2.4) and 21.4 (2.4), and

Mob-T score, 5.4 (1.1) and 5.6 (0.8).

For women, the results (SD in parentheses) of physical parameters and functional ability before and after the intervention were as follows:

height, 1.59 (0.05) m and 1.59 (0.05) m,

body weight, 69.2 (11.1) kg and 69.2 (11.1) kg,

BMI, 27.3 (4.3) kg/m2 and 27.3 (4.3) kg/m2,

handgrip, 22.0 (4.5) kg and 22.0 (4.7) kg,

reaction time, 0.22 (0.04) seconds and 0.21 (0.03) seconds,

five chair-stand time, 14.9 (4.1) seconds and 14.7 (4.5) seconds,

maximal walking speed over 10 m, 1.4 (0.3) m/second and 1.4 (0.3) m/second,

PPT score, 22.2 (2.9) and 22.5 (2.9), and

Mob-T score, 4.8 (1.5) and 4.8 (1.5).

The authors concluded that the group-based PAP did not increase significantly the functional ability.

No summary measure of benefit was used in the economic evaluation. This study was therefore a cost-consequences analysis.

The direct costs included were those of the hospital and other public health care services (e.g. hospitalisations, outpatient treatment, general practitioner visits, physiotherapists, other medical specialists and chiropractors) and of health care services provided by the municipal authorities (e.g. personal home care, assistance in the home, visiting nurse, referred day care centre, meals on wheels and transportation). Data on resource use were collected from public registers and questionnaires in the 5 months before and 5 months after the intervention. The costing was derived from prices, charges or unit costs. The resource quantities were reported separately from the costs analysed. Discounting of the costs was not deemed necessary as the study period was less than one year. The price year was 2002. The authors did not explicitly report the perspective of the analysis, although it appears to have been societal.

The cost and health service use data were reported as descriptive statistics (mean values plus SDs).

No indirect costs were reported.

Danish kroner (DKK). The exchange rate to euros (EUR) was EUR 1.0 = DKK 7.4.

A one-way sensitivity analysis was carried out to test whether the variation in costs would affect the final results. The cost ranges were derived from a national database and were adjusted to 2002 prices and weighted.

See the 'Effectiveness Results' section.

The total costs before the PAP were DKK 3,161 (SD=8,632) for hospitalisation and other health care services and DKK 690 (SD=2,767) for municipal health care services.

The total costs after the PAP were DKK 2,063 (SD=5,168) for hospitalisation and other health care services and DKK 641 (SD=2,631) for municipal health care services.

There was no significant change in the costs of either hospitalisation and other health care services or municipal health care services.

The costs and benefits were not combined.

The participants maintained their level of functional ability in the intervention period with unaltered use of health care resources.

The authors did not justify the choice of having no control group in the study. The comparator was the period of time before the intervention. You should decide if these represent relevant interventions in your own setting.

The analysis was based on a within-group, pre-post study, which was appropriate for the study question. However, it was unclear whether the study sample was representative of the study population as the participants were required to manage their own transport to and from the training facilities, and this requirement might have introduced selection bias. In addition, the internal validity of the analysis might have been weakened by the lack of power calculations. Pre-post studies may be associated with a number of confounding variables that are affected by temporal changes.

As a cost-consequences analysis was used, no summary measure of benefit was derived for the economic analysis. The comments in the 'Validity of estimate of measure of effectiveness' field (above) therefore apply.

It appears that the cost categories relevant to the perspective of Danish society have been included in the analysis. The costs and the quantities were reported separately and the price year was reported. This strengthens the transferability of the results. The generalisability to other settings was addressed through sensitivity analyses.

The authors compared their findings with those from other studies and found them, in general, to be similar. The authors acknowledged several limitations of their study. First, there was no control group. Second, all participants were required to transport themselves to and from training. Third, the study was based on open-ended responses without strict exclusion and inclusion criteria. For these reasons, the results need to be treated with caution.

The authors suggest that a multi-component PAP could maintain the functional ability level of participants without change in their use of health services. The validity of the current results could be tested within a prospective randomised trial.

Financially supported by the Ministry of Social Affairs, Denmark, and Age Forum, Denmark.

Because readers are likely to encounter and assess individual publications, NHS EED abstracts reflect the original publication as it is written, as a stand-alone paper. Where NHS EED abstractors are able to identify positively that a publication is significantly linked to or informed by other publications, these will be referenced in the text of the abstract and their bibliographic details recorded here for information

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