Economic evaluation of a wearable-based intervention to increase physical activity among insufficiently active middle-aged adults

Abstract

Background: Physical activity levels worldwide have declined over recent decades, with the average number of daily steps decreasing steadily since 1995. Given that physical inactivity is a major modifiable risk factor for chronic disease and mortality, increasing the level of physical activity is a clear opportunity to improve population health on a broad scale. The current study aims to assess the cost-effectiveness and budget impact of a Fitbit-based intervention among healthy, but insufficiently active, adults to quantify the potential clinical and economic value for a commercially insured population in the U.S. Methods: An economic model was developed to compare physical activity, health outcomes, costs, and quality-adjusted life-years (QALYs) associated with usual care and a Fitbit-based intervention that consists of a consumer wearable device alongside goal setting and feedback features provided in a companion software application. Improvement in physical activity was measured in terms of mean daily step count. The effects of increased daily step count were characterized as reduced short-term healthcare costs and decreased incidence of chronic diseases with corresponding improvement in health utility and reduced disease costs. Published literature, standardized costing resources, and data from a National Institutes of Health-funded research program were utilized. Cost-effectiveness and budget impact analyses were performed for a hypothetical cohort of middle-aged adults. Results: The base case cost-effectiveness results found the Fitbit intervention to be dominant (less costly and more effective) compared to usual care. Discounted 15-year incremental costs and QALYs were -$1,257 and 0.011, respectively. In probabilistic analyses, the Fitbit intervention was dominant in 93% of simulations and either dominant or cost-effective (defined as less than $150,000/QALY gained) in 99.4% of simulations. For budget impact analyses conducted from the perspective of a U.S. Commercial payer, the Fitbit intervention was estimated to save approximately $6.5-million dollars over 2 years and $8.5-million dollars over 5 years for a cohort of 8,000 participants. Although the economic analysis results were very robust, the short-term healthcare cost savings were the most uncertain in this population and warrant further research. Conclusions: There is abundant evidence documenting the benefits of wearable activity trackers when used to increase physical activity as measured by daily step counts. Our research provides additional health economic evidence supporting implementation of wearable-based interventions to improve population health and offers compelling support for payers to consider including wearable-based physical activity interventions as part of a comprehensive portfolio of preventive health offerings for their insured populations.