Programme Costing of a Physical Activity Programme in Primary Prevention: Should the Costs of Health Asset Assessment and Participatory Programme Development Count?

This analysis aims to discuss the implications of the “health asset concept”, introduced by the WHO, and the “investment for health model” requiring a “participatory approach” of cooperative programme development applied on a physical activity programme for socially disadvantaged women and to demonstrate the related costing issues as well as the relevant decision context. The costs of programme implementation amounted to €48,700. Adding the costs for developing the programme design of €48,800 results in total costs of €97,500; adding on top of that the costs of asset assessment running to €35,600 would total €133,100. These four different cost figures match four different types of potentially relevant decisions contexts. Depending on the decision context the total costs, and hence the incremental cost-effectiveness ratio of a health promotion intervention, could differ considerably. Therefore, a detailed cost assessment and the identification of the decision context are of crucial importance. 1. Introduction At the moment, more than half of the global population is not physically active to a satisfactory extent [1]. The increasing prevalence of physical inactivity has become an important public health problem worldwide, which has been suggested to be caused by various environmental as well as behavioural factors such as the rising use of transportation, increasing sedentary behaviour during work, and domestic activities or lack of sports and recreation facilities [2]. Physical inactivity is associated with many diseases such as obesity, coronary heart disease, diabetes mellitus type 2, osteoporosis, acute and chronic back pain as well as depression [2], and the risk-lowering positive health effects of regular physical activity have been substantiated in many reviews [3–12]. The negative health effects of physical inactivity lead to a rising economic burden to society, particularly as a result of increasing health care costs and productivity losses [13–15]. Savings due to physical activation of the population have been shown for different countries, for example, Switzerland, Austria, and USA [16–19]. The WHO proclaims the necessity of preventive efforts in policies and the environment aiming at promoting physical activity [2, 20]. Aspects of the accessibility of the target group and cross-linking as well as cooperation with health promoters are very important; these aspects are included in the “health assets concept” of health promotion introduced by the WHO [21–23]. In this concept, a health asset is any factor that enhances the ability of individuals,