Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select

Abstract

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional health, physical activity, nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach, personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained, as well as health outcomes, such as healthy days, weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days, physical activity and nutrition-related outcomes among participants, this study supports the use of Texercise Select as an intervention with substantial health and cost benefits.

Physical activity and associated medical cost savings among at-risk older adults participating a community-based health & wellness program

“…Thus, an overall gain of $7876 is adjusted to $8178.07 in 2015 dollars using PHCEPI and $9001.91 in 2017 dollars using CPIMC. While the latest estimates of the cost per participant (n = 65) for the intervention was $229[ 33 ]. Thereby, there was an overall cost of $7009 (-$14885 +$7876), yet after adjusting to 2015 dollars the cost was $6706.93 (-$14885 + $8178.07) and $5883.09 (-$14885 + $9001.91) using 2017 CPIMC.…”

“…In the results section, we report both cost estimates using the 2015 PHCEPI and 2017 CPIMC. Further, the medical cost is also compared to the relative program cost, estimated to be $229 per participant using multiple measures (e.g., estimated time volunteered for facilitators, supplies), with more detail reported elsewhere[ 33 ].…”

What If Healthy Aging Is the ‘New Normal’?

“…While there are many community-based evidence-based programs for older adults, less is known about the cost-effectiveness of these programs relative to other intervention strategies. Evidence is emerging for the cost-effectiveness of lifestyle programs that are designed to improve physical activity and dietary behaviors [ 28 ].…”

Effects of Sequential Participation in Evidence-Based Health and Wellness Programs Among Older Adults

“…Over the past decades, the evidence-based movement has produced an abundant literature about the development, implementation, and evaluation of an array of evidence-based health and wellness programs serving community-dwelling older adults ( Birkel et al, 2014 ; Boutaugh & Lawrence, 2014 ; Ory & Smith, 2015 ). Building on research- and practice-based evidence, evidence-based programs have been shown to improve health of participants and benefit society by promoting efficient utilization of limited resources and reducing health care costs ( Ahn et al, 2013 ; Akanni, Smith, & Ory, 2017 ; Carande-Kulis, Stevens, Florence, Beattie, & Arias, 2015 ; Ory et al, 2013 ). The small group format, which is most commonly offered in community settings for older adults ( Smith et al, 2017 ; Smith, Ory, Belza, & Altpeter, 2012 ), has shown to have a growing reach throughout the United States, reaching vulnerable populations (e.g., rural and/or underserved populations with limited access to care) ( Smith et al, 2017 ; Towne et al, 2014a ; Towne, Smith, Ahn, & Ory, 2014b ).…”