The Cost-Effectiveness of the SMART Work & Life Intervention for Reducing Sitting Time

Cox, Edward; Walker, Simon; Edwardson, Charlotte L.; Biddle, Stuart J. H.; Clarke-Cornwell, Alexandra M.; Clemes, Stacy A.; Davies, Melanie J.; Dunstan, David W.; Eborall, Helen; Granat, Malcolm H.; Gray, Laura J.; Healy, Genevieve N.; Maylor, Benjamin D.; Munir, Fehmidah; Yates, Thomas; Richardson, Gerry

Abstract

Sedentary behaviours continue to increase and are associated with heightened risks of morbidity and mortality. We assessed the cost-effectiveness of SMART Work & Life (SWAL), an intervention designed to reduce sitting time inside and outside of work, both with (SWAL-desk) and without (SWAL-only) a height-adjustable workstation compared to usual practice (control) for UK office workers. Health outcomes were assessed in quality-adjusted life-years (QALY) and costs in pound sterling (2019–2020). Discounted costs and QALYs were estimated using regression methods with multiply imputed data from the SMART Work & Life trial. Absenteeism, productivity and wellbeing measures were also evaluated. The average cost of SWAL-desk was £228.31 and SWAL-only £80.59 per office worker. Within the trial, SWAL-only was more effective and costly compared to control (incremental cost-effectiveness ratio (ICER): £12,091 per QALY) while SWAL-desk was dominated (least effective and most costly). However, over a lifetime horizon, both SWAL-only and SWAL-desk were more effective and more costly than control. Comparing SWAL-only to control generated an ICER of £4985 per QALY. SWAL-desk was more effective and costly than SWAL-only, generating an ICER of £13,378 per QALY. Findings were sensitive to various worker, intervention, and extrapolation-related factors. Based on a lifetime horizon, SWAL interventions appear cost-effective for office-workers conditional on worker characteristics, intervention cost and longer-term maintenance in sitting time reductions.

Citation

Cox, E., Walker, S., Edwardson, C. L., Biddle, S. J. H., Clarke-Cornwell, A. M., Clemes, S. A., …Richardson, G. (2022). The Cost-Effectiveness of the SMART Work & Life Intervention for Reducing Sitting Time. International Journal of Environmental Research and Public Health, 19(22), 14861. https://doi.org/10.3390/ijerph192214861

• Journal Article Type: Article
• Acceptance Date: Nov 9, 2022
• Online Publication Date: Nov 11, 2022
• Publication Date: Nov 11, 2022
• Deposit Date: Nov 14, 2022
• Publicly Available Date: Nov 14, 2022
• Journal: International Journal of Environmental Research and Public Health
• Publisher: MDPI
• Volume: 19
• Issue: 22
• Pages: 14861
• DOI: https://doi.org/10.3390/ijerph192214861
• Publisher URL: https://doi.org/10.3390/ijerph192214861
• Additional Information: Projects : The effectiveness of the SMArT Work & Life intervention for reducing sitting time in office workers