Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial

Tristan M. Snowsill, Afroditi Stathi, Colin J. Green, Janet Withall, Colin Greaves, Janice L Thompson, Gordon Taylor, Selena Gray, Heidi Johansen-Berg, James Bilzon, Jolanthe De Koning, Jessica C. Bollen, Sarah Moorlock, Max Western, Jack Guralnik , Jack Rejeski, Kenneth R Fox, Antonieta Medina-Lara

Research output: Contribution to journalArticlepeer-review

7 Citations (SciVal)


Background: Mobility limitations in older populations have a substantial impact on health outcomes, quality of life, and social care costs. The Retirement in Action (REACT) randomised controlled trial assessed a 12-month community-based group physical activity and behaviour maintenance intervention to help prevent decline in physical functioning in older adults at increased risk of mobility limitation. We aimed to do an economic evaluation of the REACT trial to investigate whether the intervention is cost-effective. Methods: In this health economic evaluation, we did cost-effectiveness and cost-utility analyses of the REACT programme versus standard care on the basis of resource use, primary outcome, and health-related quality-of-life data measured in the REACT trial. We also developed a decision analytic Markov model that forecasts the mobility of recipients beyond the 24-month follow-up of the trial and translated this into future costs and potential benefit to health-related quality of life using the National Health Service and Personal Social Services perspective. Participants completed questionnaire booklets at baseline, and at 6, 12, and 24 months after randomisation, which included a resource use questionnaire and the EQ-5D-5L and 36-item short-form survey (SF-36) health-related quality-of-life instruments. The cost of delivering the intervention was estimated by identifying key resources, such as REACT session leader time, time of an individual to coordinate the programme, and venue hire. EQ-5D-5L and SF-36 responses were converted to preference-based utility values, which were used to estimate quality-adjusted life-years (QALYs) over the 24-month trial follow-up using the area-under-the-curve method. We used generalised linear models to examine the effect of the REACT programme on costs and QALYs and adjust for baseline covariates. Costs and QALYs beyond 12 months were discounted at 3·5% per year. This is a pre-planned analysis of the REACT trial; the trial itself is registered with ISRCTN (ISRCTN45627165). Findings: The 12-month REACT programme was estimated to cost £622 per recipient to deliver. The most substantial cost components are the REACT session leader time (£309 per participant), venue hire (£109), and the REACT coordinator time (£80). The base-case analysis of the trial-based economic evaluation showed that reductions in health and social care usage due to the REACT programme could offset the REACT delivery costs (£3943 in the intervention group vs £4043 in the control group; difference: –£103 [95% CI −£695 to £489]) with a health benefit of 0·04 QALYs (0·009–0·071; 1·354 QALYs in the intervention group vs 1·314 QALYs in the control group) within the 24-month timeframe of the trial. Interpretation: The REACT programme could be considered a cost-effective approach for improving the health-related quality of life of older adults at risk of mobility limitations. Funding: National Institute for Health Research Public Health Research Programme.

Original languageEnglish
Pages (from-to)e327-e334
JournalThe Lancet Public Health
Issue number4
Early online date21 Mar 2022
Publication statusPublished - 30 Apr 2022

Bibliographical note

Funding Information:
This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Data sharing
Data and analysis scripts will be made available on request by qualified scientific and medical researchers for legitimate research purposes. Collected patient-level data will be deidentified and will include at least all variables necessary to reproduce the analyses. The health economic analysis plan will be made available on request. Requests should be sent to the corresponding author. Data will be available on request for 6 months from the date of publication. Investigators are invited to submit study proposal requests detailing research questions and hypotheses to receive access to these data

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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