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

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

doi:10.3390/ijerph192214861

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

Int J Environ Res Public Health. 2022 Nov 11;19(22):14861. doi: 10.3390/ijerph192214861.

Authors

Edward Cox¹, Simon Walker¹, Charlotte L Edwardson^{2

3}, Stuart J H Biddle⁴, Alexandra M Clarke-Cornwell⁵, Stacy A Clemes^{3

6}, Melanie J Davies^{2

3

7}, David W Dunstan^{8

9}, Helen Eborall^{10

11}, Malcolm H Granat⁵, Laura J Gray¹⁰, Genevieve N Healy¹², Benjamin D Maylor², Fehmidah Munir⁶, Thomas Yates^{2

3}, Gerry Richardson¹

Affiliations

¹ Centre for Health Economics, University of York, York YO10 5DD, UK.
² Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
³ NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK.
⁴ Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia.
⁵ School of Health & Society, University of Salford, Salford M6 6PU, UK.
⁶ School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
⁷ Leicester Diabetes Centre, University Hospitals of Leicester, Leicester LE5 4PW, UK.
⁸ Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
⁹ Baker-Deakin Department Lifestyle and Diabetes, Deakin University, Melbourne, VIC 3004, Australia.
¹⁰ Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.
¹¹ Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh EH16 4UX, UK.
¹² School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4067, Australia.

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.

Keywords: SMART; cost-effectiveness; healthy habits; sedentary behaviour; standing desks.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Absenteeism*
Cost-Benefit Analysis
Humans
Quality-Adjusted Life Years
Sitting Position*

Grants and funding

This study is funded by the NIHR [Public Health Research Programme (project No PR-R5-0213-25004)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The research was also supported by the Leicester Clinical Trials Unit, the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, and the NIHR Leicester Biomedical Research Centre, which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University, and the University of Leicester.