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Oct 20

Willingness to pay for a group and an individual version of the Lifestyle-integrated Functional Exercise program from a participant perspective – BMC…

Study design and sample

Data was taken from the LiFE-is-LiFE study (registered on 12/03/2018 under, identifier: NCT03462654), a multi-center, two armed, single-blinded, randomized non-inferiority trial, including community-dwelling, German-speaking people aged70 years at risk of falling, who were able to ambulate 200m without personal assistance [10]. Participants were randomized to either LiFE or gLiFE. Data was obtained at three time points (baseline, 6 months, and 12 months). WTP was assessed at 12 months.

LiFE consisted of seven home visits (1h) where a trainer presented activities for balance, strength, and general physical activity, adapting the performance and uptake of the activities to the needs of the participants. The trainer gave instructions on how to independently execute these activities and helped in implementing these activities in an individual participants daily routine. In gLiFE, the program was taught by two trainers in seven sessions (2h) to groups of 8 to 12 participants. The intervention sessions followed a detailed curriculum as trainers were not able to adapt flexibly to each individuals preferences. In both intervention arms, the participants received 2 additional booster phone calls 4 and 10 weeks after the last intervention session. A detailed description of the interventions (including a TIDieR checklist) can be found in the study protocol [10]. The development of the conceptual gLiFE framework and a content analysis as well as a qualitative analysis of the acceptance of the two program versions were published separately [13,14,15].

Intervention costs for gLiFE and LiFE which incurred for the training sessions and booster phone calls were calculated as costs per participant based on personnel and material costs and travel expenses, assuming group sizes of 12 (scenario 1, base case), 10 (scenario 2), or 8 participants (scenario 3) in gLiFE. Assumptions underlying the calculation of different scenarios are presented in Table A1 (Additional file 1). For each scenario, the amount of costs from the participant perspective was derived by subtracting different hypothetical levels of subsidy (e.g., by a health insurer) of 0, 50, and 75.

Participants WTP was elicited using Payment Cards, which are commonly used for assessing WTP for healthcare interventions [16]. Using response categories from 0, 5, 10, 20 to more than 100, participants receiving LiFE or gLiFE were asked about the amount of money they would surely be willing to pay as well as the amount they would definitely not be willing to pay for one training session of the respective program. The WTP for one training session was determined as the mean between these two values, which was then multiplied by the number of training sessions to obtain the total WTP for the intervention.

The following sample characteristics were considered in the analyses: intervention group (gLiFE/LiFE), age, sex, marital status, net household income, health insurance status (statutory vs. private), number of chronic conditions, healthcare costs, baseline fall status (non-faller vs. faller in the previous 6 months), motivation to exercise, satisfaction with the program, and training frequency (number of LiFE activities performed per week) at 12-month follow-up.

For the calculation of healthcare costs, costs from inpatient and outpatient service utilization, as well as medication and formal care use in the previous 6 months before the baseline assessment were considered. Resource utilization was monetarily valued in Euro () based on standardized unit costs [17] and inflated to the year 2018 [18].

Motivation to exercise was measured based on the autonomous motivation score of the Behavioral Regulation in Exercise Questionnaire (BREQ-3) [19], ranging from 0 to 4, with higher scores indicating higher motivation.

Satisfaction with the program was measured on a 5-point Likert scale (higher scores indicate higher satisfaction) and by a German school grade system using response categories from 1 (best grade) to 6 (worst grade).

The WTP was descriptively analyzed for persons with different sample characteristics for the total sample as well as for gLiFE and LiFE separately. Potential determinants of WTP were examined by linear regression models including the group variable (gLiFE/LiFE), sex, age, income, number of chronic conditions, healthcare costs, and motivation to exercise as independent variables. The mean net benefit from the participant perspective was calculated for different intervention scenarios (varying group sizes in gLiFE) and levels of subsidy by subtracting intervention costs from the WTP. The incremental net benefit of gLiFE over LiFE was determined by linear regression models adjusted for the potential determinants mentioned above.

Skewness of data was taken into account using a bootstrapped sample with n=1,000 replicates. All analyses were conducted using STATA/SE 16.0 [StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC]. The significance level was set to 0.05.

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Willingness to pay for a group and an individual version of the Lifestyle-integrated Functional Exercise program from a participant perspective - BMC...

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