A structured, group-based exercise program added to standard outpatient appears to boost mental health outcomes without substantially increasing overall health-care costs. That’s the news from a recent economic evaluation appearing in the latest issues of The Lancet Psychiatry.
Researchers based their analysis on data gleaned from ImPuls, a six-month transdiagnostic German exercise program. It included adults with moderate to severe depression, post-traumatic stress disorder, panic disorder, agoraphobia, or insomnia.
Although researchers have long acknowledged that exercise therapy boasts mental health benefits. But questions have lingered as to how much of benefit. This study, the authors claim, is one of the first to assess cost-effectiveness in a broad outpatient population instead of a single diagnosis group.
Methodology
Researchers looked at data from a randomized controlled trial that included 400 adults between the ages of 18 and 65. They compared treatment as usual to a treatment regime that included the ImPuls program. The intervention combined four weeks of supervised group aerobic exercise with a longer, partially supervised phase that emphasized independent activity, behavioral strategies, regular therapist check-ins, and support through a smartphone app.
The researchers tracked health outcomes for a year, while monitoring detailed statutory health insurance claims that captured real-world health-care use and costs.
Surprising Results
After 12 months, participants who received ImPuls alongside standard care showed dramatically greater drops in psychological distress, at least according to the Brief Symptom Inventory-18.
Those same participants also enjoyed modest (yet meaningful) gains in health-related quality of life, translating into an average gain of 0.032 quality-adjusted life-years (QALYs) over that single year.
From a cost perspective, the benefit seemed to be slightly more nuanced. Total health-care costs during the year after enrollment were slightly higher for those in the exercise program once researchers accounted for the intervention costs.
That being said, the researchers failed to record any statistically significant differences in overall health-care spending between the groups. And inpatient psychiatric hospital costs appeared to be much lower among ImPuls participants.
Once researchers considered costs and outcomes together, the intervention compared favorably with commonly cited cost-effectiveness benchmarks. The estimated cost was €17,543 per QALY gained. At a willingness-to-pay threshold of €30,000 per QALY, the probability that ImPuls was cost-effective surged to 77 percent. Sensitivity analyses that tested alternative assumptions produced similar results.
Caveats and Conclusions
The authors warn that the study does have its limitations. They conceded that they conducted their study during the COVID-19 pandemic, which might have influenced both mental health trajectories and service use.
They added that the analysis also focused on the statutory health insurance perspective, excluding broader societal costs such as productivity losses beyond sick leave.
Nevertheless, the authors insist that what they found suggests that structured exercise programs can serve as economically reasonable supplements to standard mental health care.
Taken together, the results bolster the case for integrating exercise-based interventions into outpatient mental health services, even if they don’t perform as well as expected as cost-saving measures. They remain viable as affordable ways to boost outcomes across a range of common mental disorders.
Further Reading
Exercise is Even Better Than We Thought for Brain Health
