Cost-Utility Analyses of Interventions to Increase Physical Activity in Israeli Adults

Physical inactivity (or sedentariness) is a serious and expensive risk factor for many chronic diseases. Approximately NIS 1.5 billion in direct healthcare costs may be attributed to sedentariness in Israel in 2008. This represents 0.2% of Israel’s GNP. In this study, cost-utility ratios of interventional modalities for increasing physical activity were calculated by incorporating local Israel epidemiologic, economic and demographic parameters into published international analyses.

Several preventive interventions were found to be cost saving, meaning that the treatment costs averted by the decrease in morbidity exceed the cost of the intervention. These included:

  • Clinical preventive programs:
    • The Green Prescription: A multifaceted intervention using pre-identification of sedentary individuals by clinic staff, primary-care physician training in motivational interviewing, oral and written counseling using the Green Prescription form, monthly telephone counseling by exercise specialists, patient feedback by clinic staff and provision of information to patients regarding community physical activity initiatives.
    • The STEP Test Exercise Prescription: Involves exercise counseling and prescription of a tailored exercise prescription for patients aged 65 and above. Patient exercise on a stepper device facilitated calculation of an exercise training target heart rate.
  • Community level campaigns:
    • Pedometer use promoted via a media campaign (including setting step goals and recording step diaries), engaging health professionals in promoting physical activity, worksite physical activity promotion and local government environmental supports such as signage and walking trails.
    • Campaigns in the mass media along with distribution of promotional materials, and community-level support programs and strategies.

Programs implemented abroad that were found to be very cost effective, in the sense of achieving an increase in quality-adjusted life years at a relatively low cost, included active transport programs with tailored information and incentives to encourage walking, a combination of paid media advertisements/public relations events/health promotion activities at worksites, places of worship, and local organizations, exposure to dedicated websites, supervised group exercise classes, and GP-delivered exercise advice, along with exercise diaries and the option of joining group activities.

Adopting a variety of the many cost-saving or very cost-effective interventions delineated in this review will contribute to the achievement of the Healthy Israel 2020 target to decrease sedentariness by 9.3 percentage points and would save the health services nearly NIS 197 million, as well as prevent considerable losses of productivity due to absenteeism and lower productivity.