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Are Office-Based Workplace Interventions Designed to Reduce Sitting Time Cost-Effective Primary Prevention Measures for Cardiovascular Disease? A Systematic Review and Modelled Economic Evaluation

by Lan Gao 1,2,3,*, Phuong Nguyen 1,2, David Dunstan 4,5,6,7,8,9 and Marjory Moodie 1,2
1
Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, VIC 3127, Australia
2
Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, VIC 3127, Australia
3
School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan NSW 2308, Australia
4
Baker Heart and Diabetes Institute, Melbourne 3004, Australia
5
School of Public Health, The University of Queensland, Brisbane 4072, Australia
6
School of Sport Science, Exercise & Health, University of Western Australia, Perth 6907, Australia
7
School of Exercise and Nutrition Sciences, Deakin University, Melbourne 3125, Australia
8
School of Public Health & Preventive Medicine, Monash University, Melbourne 3800, Australia
9
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3003, Australia
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(5), 834; https://doi.org/10.3390/ijerph16050834
Received: 8 January 2019 / Revised: 26 February 2019 / Accepted: 28 February 2019 / Published: 7 March 2019
(This article belongs to the Section Health Economics)
Objectives: To assess the cost-effectiveness of workplace-delivered interventions designed to reduce sitting time as primary prevention measures for cardiovascular disease (CVD) in Australia. Methods: A Markov model was developed to simulate the lifetime cost-effectiveness of a workplace intervention for the primary prevention of CVD amongst office-based workers. An updated systematic review and a meta-analysis of workplace interventions that aim to reduce sitting time was conducted to inform the intervention effect. The primary outcome was workplace standing time. An incremental cost-effectiveness ratio (ICER) was calculated for this intervention measured against current practice. Costs (in Australia dollars) and benefits were discounted at 3% annually. Both deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. Results: The updated systematic review identified only one new study. Only the multicomponent intervention that included a sit-and-stand workstation showed statistically significant changes in the standing time compared to the control. The intervention was associated with both higher costs ($6820 versus $6524) and benefits (23.28 versus 23.27, quality-adjusted life year, QALYs), generating an ICER of $43,825/QALY. The DSA showed that target age group for the intervention, relative risk of CVD relative to the control and intervention cost were the key determinants of the ICER. The base case results were within the range of the 95% confidence interval and the intervention had a 85.2% probability of being cost-effective. Conclusions: A workplace-delivered intervention in the office-based setting including a sit-and-stand desk component is a cost-effective strategy for the primary prevention of CVD. It offers a new option and location when considering interventions to target the growing CVD burden. View Full-Text
Keywords: sedentary behaviour; workplace intervention; multicomponent; cost-effective analysis; cardiovascular disease; primary prevention sedentary behaviour; workplace intervention; multicomponent; cost-effective analysis; cardiovascular disease; primary prevention
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Gao, L.; Nguyen, P.; Dunstan, D.; Moodie, M. Are Office-Based Workplace Interventions Designed to Reduce Sitting Time Cost-Effective Primary Prevention Measures for Cardiovascular Disease? A Systematic Review and Modelled Economic Evaluation. Int. J. Environ. Res. Public Health 2019, 16, 834.

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