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Cost-utility analysis of an outdoor gym intervention in Zimbabwe: Markov model
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
2019 (English)Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Background: Obesity and overweight are a growing pandemic worldwide and serious public health concerns as they are major risk factors for many non-communicable diseases (NCDs). These NCDs cause premature deaths – many occurring in low to middle income countries- and they come with huge economic impact. Modifying behaviours, such as physical inactivity, unhealthy diets and the harmful use of alcohol and tobacco are key in mitigating the incidence of NCDs. The aim of this study is to evaluate the cost-effectiveness (dollars per quality-adjusted life year [QALY]) of an outdoor gym in reducing and maintaining a healthy weight for participants in Harare, Zimbabwe.

Methods: A static Markov Model with 5 mutually exclusive states and a one-year transition cycle was used to follow a cohort of 1 million participants aged 15 years for a lifetime. The cohort would use a public outdoor gym at the World Health Organisation (WHO) recommended physical activity levels to achieve and maintain weight loss. The resulting weight loss modulates the risk of participants developing coronary heart disease (CHD), Type 2 Diabetes Mellitus (T2DM) or both conditions. A healthcare perspective was taken when costs and benefits were estimated. The input parameters used for both no intervention and intervention arms were inferred from available literature. Health outcomes were measured in Quality Adjusted Life Years (QALY) and from there Incremental Cost-Effectiveness Ratios (ICERs) were calculated for the two arms. One-way and two-way sensitivity analyses were also done to measure robustness of the model.

Results: The outdoor gym intervention dominates the no intervention arm with a discounted ICER of $2 806.13 using a healthcare provider perspective. The discounted QALY gain was 73 912 with an associated discounted incremental cost of $ 207,4 million. The model showed sensitivity to utility weights, intervention effect size and discounting rates.

Conclusions: Basing on the World Health Organisation (WHO) cost-effectiveness threshold suggestion the outdoor gym intervention is cost effective. Zimbabwe’s GDP per capita threshold range as of 2016 is $1 272- $3 816. These results ought to motivate decision makers to consider investing in community or population-level physical interventions to curb the incidence and prevalence of NCDs.

Place, publisher, year, edition, pages
2019. , p. 37
Series
Centre for Public Health Report Series, ISSN 1651-341X ; 2019:12
Keywords [en]
Outdoor gym, intervention, obesity, overweight, Zimbabwe, cost-utility analysis, Markov model
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-165730OAI: oai:DiVA.org:umu-165730DiVA, id: diva2:1374881
Educational program
Master's Programme in Public Health
Presentation
2019-05-23, Room A310, Caring Sciences building, Umeå University, Umeå, 10:00 (English)
Supervisors
Examiners
Available from: 2019-12-05 Created: 2019-12-03 Last updated: 2019-12-10Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
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Language
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