Date Published: March 25, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Silke B. Wolfenstetter, Bernd Schweikert, Jürgen John.
This analysis aims to discuss the implications of the “health asset concept”, introduced by the WHO, and the “investment for health model” requiring a “participatory approach” of cooperative programme development applied on a physical activity programme for socially disadvantaged women and to demonstrate the related costing issues as well as the relevant decision context.
The costs of programme implementation amounted to €48,700. Adding the costs for developing the programme design of €48,800 results in total costs of €97,500; adding on top of that the costs of asset assessment running to €35,600 would total €133,100. These four different cost figures match four different types of potentially relevant decisions contexts. Depending on the decision context the total costs, and hence the incremental cost-effectiveness ratio of a health promotion intervention, could differ considerably. Therefore, a detailed cost assessment and the identification of the decision context are of crucial importance.
At the moment, more than half of the global population is not physically active to a satisfactory extent . The increasing prevalence of physical inactivity has become an important public health problem worldwide, which has been suggested to be caused by various environmental as well as behavioural factors such as the rising use of transportation, increasing sedentary behaviour during work, and domestic activities or lack of sports and recreation facilities . Physical inactivity is associated with many diseases such as obesity, coronary heart disease, diabetes mellitus type 2, osteoporosis, acute and chronic back pain as well as depression , and the risk-lowering positive health effects of regular physical activity have been substantiated in many reviews [3–12]. The negative health effects of physical inactivity lead to a rising economic burden to society, particularly as a result of increasing health care costs and productivity losses [13–15]. Savings due to physical activation of the population have been shown for different countries, for example, Switzerland, Austria, and USA [16–19].
The results of our various cost calculations are shown in detail in different perspectives and partitions in Tables 3–7. First of all, in Table 3, the results of calculating the imputed costs of equipment and the results of the corresponding sensitivity analysis (by varying the working life of the equipment) are reported. In the baseline assessment, the total equipment costs over the three settings added up to 284.9 € for the low-intensity programme, 619.0 € for the high-intensity programme, and 903.9 € for both programmes.
Dependent on the chosen perspective and the scope of costing, total costs varied substantially. The appropriate scope of costing depends on the type of decision that has to be made. Four typical decisions contexts should be distinguished (see also superscript numbers in Table 7):
Dependent on the scope of costing and the chosen perspective, total programme costs varied substantially. From the programme payer’s (societal) perspective, the costs of programme implementation amounted to €43,900 (€48,700). Adding the costs for developing the programme design of €48,800 results in total costs of €92,700 (€97,500); adding on top of that the costs of asset assessment running to €35,600 would total €128,300 (€133,100). Interestingly, programme implementation costs including recruitment costs make up only 34% to 37% of total costs, dependent on the chosen perspective of analysis.