Browsing by Author "Cowper, Patricia A"

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    Differences between completely physically inactive and low active older men and their response to an exercise intervention: the Veterans LIFE study.
    (Healthy aging research, 2015-01) Peterson, Matthew J; Pieper, Carl F; Sloane, Richard; Crowley, Gail M; Cowper, Patricia A; McConnell, Eleanor S; Bosworth, Hayden B; Ekelund, Carola C; Pearson, Megan P; Hall, Katherine S; Morey, Miriam C
    Physical activity interventions typically do not report behavioral changes in activity sub-groups. The aim of this study was to compare baseline differences and changes in physical activity between truly physically inactive men and low active men enrolled in a twelve-month, home-based physical activity intervention.Veterans with a mean age of 77.6 years were randomized to either a physical activity intervention or usual care. Measures included self-reported physical activity, physical function, and physical performance.At baseline, the physically inactive group reported more symptoms and poorer functioning than the low active group. At 12 months, physically inactive men randomized to the intervention group increased their physical activity to an average of 73.3 minutes per week. Physically inactive individuals randomized to the control group were eight times more likely to remain inactive compared to the low active group.Completely physically inactive older men can markedly increase physical activity levels with a long-term intervention. Without such intervention, the likelihood of this group remaining inactive is eightfold.
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    Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial.
    (Journal of the American Geriatrics Society, 2017-03) Cowper, Patricia A; Peterson, Matthew J; Pieper, Carl F; Sloane, Richard J; Hall, Katherine S; McConnell, Eleanor S; Bosworth, Hayden B; Ekelund, Carola C; Pearson, Megan P; Morey, Miriam C

    Objectives

    To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans.

    Design

    Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance, physical activity, function, disability, and medical resource use and cost.

    Setting

    Veterans Affairs Medical Center, Durham, North Carolina.

    Participants

    Male veterans aged ≥70 years (n = 398).

    Intervention

    An experienced health counselor provided baseline in-person exercise counseling, followed by telephone counseling at 2, 4, and 6 weeks, and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention, followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly.

    Measurements

    Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated.

    Results

    The total direct cost of the intervention per participant was $459, 85% of which was counselor effort. With overhead, program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention, versus $12,052 with usual care (difference = -$1,634 (95% confidence interval = -$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes, the intervention cost $4,971 per additional patient reaching target exercise levels, or $4,640 per patient achieving a clinically significant change in rapid gait speed.

    Conclusion

    Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.
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    Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease.
    (Annals of internal medicine, 2016-07) Mark, Daniel B; Federspiel, Jerome J; Cowper, Patricia A; Anstrom, Kevin J; Hoffmann, Udo; Patel, Manesh R; Davidson-Ray, Linda; Daniels, Melanie R; Cooper, Lawton S; Knight, J David; Lee, Kerry L; Douglas, Pamela S; PROMISE Investigators

    Background

    PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing.

    Objective

    To conduct an economic analysis for PROMISE (a major secondary aim of the study).

    Design

    Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550).

    Setting

    190 U.S. centers.

    Patients

    9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months.

    Measurements

    Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods.

    Results

    The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, -$634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small.

    Limitation

    Cost weights for test strategies were obtained from sources outside PROMISE.

    Conclusion

    Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.

    Primary funding source

    National Heart, Lung, and Blood Institute.