Nationwide exercise programs a cost-effective way to improve public health in SG

Nationwide exercise programs can significantly reduce healthcare costs in Singapore by preventing diabetes, hypertension, and associated mortality, as suggested in a cost-utility analysis.

“We examined the cost-effectiveness of the Singapore National Steps Challenge (NSC), an annual nationwide mobile health intervention to increase physical activity, from both the healthcare provider perspective, which only considers the direct costs, and the societal perspective, which considers both the direct and indirect costs,” the investigators said.

Based on a mean cohort size of 654,500 participants aged 17 years or older, conducting the NSC yearly for 10 years was projected to prevent 6,200 diabetes cases, 10,500 hypertension cases, and 4,930 deaths. This reduction in cases was estimated to save SGD 448 million in direct healthcare costs and an additional SGD 965 million when indirect costs such as productivity losses and costs due to early mortality were considered, for a total reduction of SGD 1.41 billion in societal costs. [JMIR Public Health Surveill 2024;doi:10.2196/46178]

An estimated total of 78,800 quality-adjusted life years (QALY) would be gained. At a willingness-to-pay threshold of SGD 10,000 per QALY gained, the NSC would be cost-effective, the investigators noted. The model was most sensitive to changes in the inpatient cost of treatment for diabetes complications, time horizon, and program compliance.

“Our analysis showed a huge reduction in healthcare costs when we considered differential costs among participants with the same disease but with different physical activity levels. This suggests that minimal change in clinical symptoms and costs for diabetes and hypertension can collectively contribute to a significant impact on public health as a whole. This also suggests that the reduction of healthcare costs is substantial if the diseases can be better managed by having a higher physical activity level,” the investigators explained.

They also acknowledged that conducting a nationwide physical activity intervention such as the NSC could incur huge costs upfront due to the logistics and the cost of the incentives. However, these costs may eventually be offset due to the reduction in healthcare use resulting in a lower incidence of chronic diseases from increased physical activity, they pointed out.

“Even in the short term (5 years), we project that there will be a decrease in the incidence of diabetes and hypertension cases and a decrease in mortality, leading to a reduction in healthcare costs and QALY gained… However, the NSC was more cost-saving if conducted for a longer period. If the NSC was conducted throughout the participants’ lifetime, it could be even more cost-saving,” the investigators said.

Looking at a study involving people with cardiovascular disease, the average healthcare costs among those who met physical activity guidelines were lower by more than SGD 3,500 than among those who did not meet guidelines, they continued.

With approximately one in five adults and one in two older adults living with more than one chronic condition, a large-scale physical activity intervention such as the NSC could be a cost-effective approach to reducing the burden of chronic diseases, the investigators said. [J Am Heart Assoc 2016;5:e003614; Ageing Res Rev 2011;10:430-439]

The present analysis was conducted using a Markov model, and a Monte Carlo simulation with 1,000 samples was applied to compare a scenario wherein NSC was conducted yearly for 10 years against a no-intervention scenario. All future costs and QALYs were discounted at 3 percent per annum.