A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace

BACKGROUND: Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer’s perspective. METHODS: Employees used a 'loyalty card’ to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates. RESULTS: The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds. CONCLUSIONS: The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer’s perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable “business model” which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges

Environmental, health and equity effects of urban green space interventions

As populations become increasingly urbanised, the preservation of urban green space becomes paramount. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing, urban green space for environmental, health and well-being benefits. This chapter highlights aspects to be considered when designing and evaluating urban green space interventions that aim to maximize environmental, social and health benefits, and address equity issues. Based on a review of international research evidence and a compilation of European case studies, the chapter addresses the variety of green space intervention approaches and their related impacts. There was strong evidence to support park-based and greenway/trail interventions employing a dual-approach (i.e. a physical change to the urban green space and promotion/marketing programmes particularly for park use and physical activity); strong evidence for the greening of vacant lots for health, well-being (e.g. reduction in stress) and social (e.g. reduction in crime) outcomes; strong evidence for the provision of urban street trees and green infrastructure for storm water management for environmental outcomes (e.g. increased biodiversity, reduced air pollution, climate change adaptation). Urban green space has an important role to play in creating a culture of health and well-being. Results show promising evidence to support the use of certain urban green space interventions for health, social and environmental benefits. The findings have important implications for policymakers, practitioners and researchers