1. Cost-effectiveness of a Physical Activity Awareness Campaign Jennie Petersen, MSc. Student Dept. of Community Health Sciences Faculty of Medicine University of Calgary

2. VERB Awareness Campaign VERB - Physical Activity Awareness Campaign  Target: Children 9-13 years old  National-level campaign implemented in 2002 in the USA Two-year evaluation in 2004 (Huhman et al., 2007)  Purpose: Examine effect of VERB on children’s behaviour  Study design: Longitudinal cohort, n=2257  Measurement tool: Youth Media Campaign Longitudinal Survey  Result: Significant dose-response relationship between ‘aware’ and ‘unaware’ children

3. Research Questions 1) What is the cost-effectiveness (CE) of the VERB physical activity (PA) awareness campaign? 2) What are the implications of the results for Canada?

4. Methods Evidence from the VERB campaign was used to determine the CE of a PA campaign Extrapolated results to 60 years of age and estimated:  Cases of CVD prevented  Net medical costs (cost-offsets) Cost-Effectiveness Analysis (Modeling)  Compared PA campaign with ‘Do Nothing’ strategy  Adopted a health care payer perspective  Estimated (net) cost per case of CVD prevented

5. Model

6. 81% 61% 29% 17%

7. VariableBase Case (95%CI)Data Source Campaign Awareness0.81 VERB Study (Huhman et al., 2007) Probability of being Active if Aware0.612 (0.583-0.640) Probability of being Active if Unaware0.457 (0.389-0.525) Cost of Campaign / # Children$194 M / 21 M children (US$) Average age of participants (end of campaign) 13 years (11-15) Probability of Active Child becoming Active Adult 0.2925 (0.14-0.44)Telama et al., 2005 Probability of CVD if Active0.1668 Wang et al., 2004 Probability of CVD if Sedentary0.2363 Medical cost of CVD if Active$3784 (US$) Medical cost of CVD if Sedentary$6313 (US$) Medical cost of No CVD if Active$1476 (US$) Medical cost of No CVD if Sedentary$1590 (US$) Avg. age of onset of CVD59.8 years (51.4-68.2)Weaver, et al., 1997

8. Results  Cost of the VERB campaign (US) $9,240 per 1000 children  Cases of no CVD PA Campaign: 775.5 cases per 1000 children Do Nothing Strategy: 772.9 cases per 1000 children Difference:2.6 per 1000 children  Lifetime medical costs PA Campaign: (US) $33,414,000 per 1000 children Do Nothing Strategy: (US) $33,495,000 per 1000 children Difference: (US) -$81,000 per 1000 children  Net costs of the intervention (US) -$71,760 per 1000 children … cost savings!

9. Sensitivity / Scenario Analysis Result remains robust to changes in:  Awareness levels  Probability of an active child becoming an active adult  Prevalence of CVD in active and inactive people  Campaign effectiveness Result was not robust to changes in:  Medical Costs

10. Assumptions … limitations Difference in PA attributed solely to the campaign Sedentary children remain sedentary as adults PA behaviour doesn’t change over lifetime, except from adolescence into adulthood Excluded health care costs associated with PA Only included benefits of PA in preventing CVD

11. Conclusions VERB PA Campaign aimed at children appears highly cost-effective Strength of this CE is limited by strength of evidence / assumptions used in the model Results remain robust to changes in most assumptions … but not all Relied on US data! … Implications for Canada?

12. Acknowledgements Collaborators:  Dr. Alan Shiell  Dr. Tish Doyle-Baker  Ms. Michelle Fry Special Thanks:  Dr. Herb Emery  Dr. Fiona Shrive  Dr. Braden Manns Funding: Canadian Institutes of Health Research