Scaling up cost-effective physical activity interventions in a culturally diverse setting

Before this PhD project started, evidence showed that physical inactivity causes a substantial health and economic burden globally. For Switzerland, there was research available investigating the burden of physical inactivity. However, this research estimated the burden for the entire country without differentiating between sub regions although the prevalence of physical inactivity varies significantly between the French-, German- and Italian-speaking regions. Therefore, this thesis had three aims: 1. Estimating the health and economic burden of physical inactivity in Switzerland and for the French-, German- and Italian-speaking language regions separately 2. Systematically reviewing trial-based economic evaluations of interventions to reduce physical inactivity 3. Developing a health economic model that investigates the cost-effectiveness of physical activity interventions in Switzerland and its three language regions The thesis showed that the burden of physical inactivity in Switzerland is substantial and that the French- and Italian-speaking regions are over-proportionally affected. These two regions distinguish themselves from the German-speaking region by having a higher prevalence of physical inactivity, higher per capita health care spending, and higher disease prevalence. Due to the substantial burden of physical inactivity, interventions aiming to increase physical activity should be considered. In the systematic review we conducted, we found evidence from randomized controlled trials indicating the cost-effectiveness of some physical activity interventions for primary prevention in adults. These interventions were then further evaluated in a cost-effectiveness model built for the Swiss setting. This model showed that Swiss policy makers have cost-effective options of physical activity promotion. We recommend that individualized advice and general practitioner referral be further evaluated as interventions and that decision-making considers the specifics of the Swiss language regions. Furthermore, we judge the cost-effectiveness model to be not only relevant for Switzerland but also for other multicultural countries. Based on similar data availability, our model has the potential to be applied beyond Switzerland, primarily to high-income countries with a comparable background, as a tool to guide societal efforts in primary prevention of physical-inactivity-related diseases.