Health Gain, Cost Impacts, and Cost-Effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Physical Activity: Modeling Study

Mizdrak, Anja; Telfer, Kendra; Direito, Artur; Cobiac, Linda; Blakely, Tony; Cleghorn, Christine; Wilson, Nick

doi:10.2196/18014

Cited by 11 publications

(32 citation statements)

References 31 publications

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“…Specifically, smartphone ownership was higher than previously modeled and the reach of the mass media campaign was lower. We also conceptualized some of the pathway between the initial intervention (ie, the mass media campaign) to the effect size (ie, the effect of weight loss app use on BMI) based on new evidence that was incorporated into other modeling on mass media campaigns [ 37 ]. In our sensitivity analyses, we used the previously modeled effect size to isolate how much of a difference was due to the revised pathway versus the effect size.…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that such a campaign was not cost-effective in the base case analysis [ 36 ]. Another study using similar methods assessed the potential of a mass media campaign to promote smartphone apps for physical activity and found that it was unlikely to be cost-effective at the population level, although the health impact and cost-effectiveness estimates were highly sensitive to assumptions around long-term adherence [ 37 ]. The evidence on the cost-effectiveness of mass media campaigns is primarily from tobacco control [ 29 ], and previous research indicates that a mass media campaign for promoting smoking cessation apps is likely to be cost saving [ 38 ].…”

Section: Introductionmentioning

confidence: 99%

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The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study

Jones¹,

Grout²,

Wilson³

et al. 2022

JMIR Form Res

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Background Evidence suggests that smartphone apps can be effective in the self-management of weight. Given the low cost, broad reach, and apparent effectiveness of weight loss apps, governments may seek to encourage their uptake as a tool to reduce excess weight in the population. Mass media campaigns are 1 mechanism for promoting app use. However, the cost and potential cost-effectiveness are important considerations. Objective The aim of our study was to use modeling to assess the health impacts, health system costs, cost-effectiveness, and health equity of a mass media campaign to promote high-quality smartphone apps for weight loss in New Zealand. Methods We used an established proportional multistate life table model that simulates the 2011 New Zealand adult population over the lifetime, subgrouped by age, sex, and ethnicity (Māori [Indigenous] or non-Māori). The risk factor was BMI. The model compared business as usual to a one-off mass media campaign intervention, which included the pooled effect size from a recent meta-analysis of smartphone weight loss apps. The resulting impact on BMI and BMI-related diseases was captured through changes in health gain (quality-adjusted life years) and in health system costs. The difference in total health system costs was the net sum of intervention costs and downstream cost offsets because of altered disease rates. An annual discount rate of 3% was applied to health gains and health system costs. Multiple scenarios and sensitivity analyses were conducted, including an equity adjustment. Results Across the remaining lifetime of the modeled 2011 New Zealand population, the mass media campaign to promote weight loss app use had an estimated overall health gain of 181 (95% uncertainty interval 113-270) quality-adjusted life years and health care costs of –NZ $606,000 (–US $408,000; 95% uncertainty interval –NZ $2,540,000 [–US $1,709,000] to NZ $907,000 [US $610,000]). The mean health care costs were negative, representing overall savings to the health system. Across the outcomes examined in this study, the modeled mass media campaign to promote weight loss apps among the general population would be expected to provide higher per capita health gain for Māori and hence reduce health inequities arising from high BMI, assuming that the intervention would be as effective for Māori as it is for non-Māori. Conclusions A modeled mass media campaign to encourage the adoption of smartphone apps to promote weight loss among the New Zealand adult population is expected to yield an overall gain in health and to be cost-saving to the health system. Although other interventions in the nutrition and physical activity space are even more beneficial to health and produce larger cost savings (eg, fiscal policies and food reformulation), governments may choose to include strategies to promote health app use as complementary measures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study

Jones¹,

Grout²,

Wilson³

et al. 2022

JMIR Form Res

Self Cite

View full text Add to dashboard Cite

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“…Current evidence indicates that physical activity interventions would likely provide minimal chronic disease reduction benefits to adults aged <40 years in NZ [24,27]. Therefore, the age range for the intervention was restricted to 40 to 79 years.…”

Section: Intervention Specificationmentioning

confidence: 99%

“…When compared with selected health interventions in NZ, according to methodologically compatible modeling studies, we found that the prescription of smartphone apps for physical activity promotion in primary care was likely to provide larger health gains and cost savings for the health system than a mass media campaign for physical activity apps [27], a mass media campaign for weight loss apps [50], or weight loss counseling by nurses in primary care [51] in NZ (Table 6). However, the intervention was less effective than a mass media campaign to promote a smoking cessation app in NZ [52].…”

Section: Comparison With Prior Workmentioning

confidence: 99%

Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings

Grout¹,

Telfer²,

Wilson³

et al. 2021

J Med Internet Res

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Background Inadequate physical activity is a substantial cause of health loss worldwide, and this loss is attributable to diseases such as coronary heart disease, diabetes, stroke, and certain forms of cancer. Objective This study aims to assess the potential impact of the prescription of smartphone apps in primary care settings on physical activity levels, health gains (in quality-adjusted life years [QALYs]), and health system costs in New Zealand (NZ). Methods A proportional multistate lifetable model was used to estimate the change in physical activity levels and predict the resultant health gains in QALYs and health system costs over the remaining life span of the NZ population alive in 2011 at a 3% discount rate. Results The modeled intervention resulted in an estimated 430 QALYs gained (95% uncertainty interval 320-550), with net cost savings of 2011 NZ $2.2 million (2011 US $1.5 million) over the remaining life span of the 2011 NZ population. On a per capita basis, QALY gains were generally larger in women than in men and larger in Māori than in non-Māori. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions on intervention uptake and decay. For example, the scenario analysis with the largest benefits, which assumed a 5-year maintenance of additional physical activity levels, delivered 1750 QALYs and 2011 NZ $22.5 million (2011 US $15.1 million) in cost savings. Conclusions The prescription of smartphone apps for promoting physical activity in primary care settings is likely to generate modest health gains and cost savings at the population level in this high-income country. Such gains may increase with ongoing improvements in app design and increased health worker promotion of the apps to patients.

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“…the top 2% reporting more than 500,000 monthly active users (MAUs) [ 25 ]). Unlike previous cost-effectiveness analyses of physical activity interventions more broadly (outside the mHealth context e.g., mass media campaigns), [ 26 – 28 ] analyses should model risk reductions based on objectively-measured (vs. subjective measures) and longer-term (6+ months, the theoretical threshold for behaviour maintenance) [ 29 ] changes in physical activity [ 19 , 20 , 30 ]. Age- and sex-specific models should also be used since disease incidence and mortality rates vary widely by demographic group [ 19 , 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

Is it worth it? Cost-effectiveness analysis of a commercial physical activity app

et al. 2021

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Background Government interest in investing in commercial physical activity apps has increased with little evidence of their cost-effectiveness. This is the first study to our knowledge to examine the cost-effectiveness of a commercial physical activity app (Carrot Rewards) despite there being over 100,000 in the major app stores. Methods A cost-effectiveness analysis was performed to calculate the incremental cost-effectiveness ratio (ICER) of the app compared to a no-intervention reference scenario using a five-year time horizon. Primary data was collected between 2016 and 2017. Data synthesis, model creation, and statistical analyses were conducted between 2019 and 2020. An age-, sex-, and geography-dependent Markov model was developed assuming a public healthcare payer perspective. A closed cohort (n = 38,452) representing the population reached by Carrot Rewards in two Canadian provinces (British Columbia, Newfoundland & Labrador) at the time of a 12-month prospective study was used. Costs and effects were both discounted at 1.5% and expressed in 2015 Canadian dollars. Subgroup analyses were conducted to compare ICERs between provinces, sexes, age groups, and engagement levels. Results Carrot Rewards had an ICER of $11,113 CAD per quality adjusted life year (QALY), well below a $50,000 CAD per QALY willingness-to-pay (WTP) threshold. Subgroup analyses revealed that the app had lower ICERs for British Columbians, females, highly engaged users, and adults aged 35-64 yrs., and was dominant for older adults (65 + yrs). Deterministic sensitivity analyses revealed that the ICER was most influenced by the relative risk of diabetes. Probabilistic sensitivity analyses revealed varying parameter estimates predominantly resulted in ICERs below the WTP threshold. Conclusions The Carrot Rewards app was cost-effective, and dominant for older adults. These results provide, for the first time, rigorous health economic evidence for a commercial physical activity app as part of public health programming.

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Health Gain, Cost Impacts, and Cost-Effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Physical Activity: Modeling Study

Cited by 11 publications

References 31 publications

The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study

The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study

Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings

Is it worth it? Cost-effectiveness analysis of a commercial physical activity app

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