The Cost-Effectiveness of the SMART Work & Life Intervention for Reducing Sitting Time

Edward Cox, Simon Walker, Charlotte L Edwardson, Stuart J H Biddle, Alexandra M Clarke-Cornwell, Stacy A Clemes, Melanie J Davies, David W Dunstan, Helen Eborall, Malcolm H Granat, Laura J Gray, Genevieve N Healy, Benjamin D Maylor, Fehmidah Munir, Thomas Yates, Gerry Richardson

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Sedentary behaviours continue to increase and are associated with heightened risks of morbidity and mortality. We assessed the cost-effectiveness of SMART Work & Life (SWAL), an intervention designed to reduce sitting time inside and outside of work, both with (SWAL-desk) and without (SWAL-only) a height-adjustable workstation compared to usual practice (control) for UK office workers. Health outcomes were assessed in quality-adjusted life-years (QALY) and costs in pound sterling (2019-2020). Discounted costs and QALYs were estimated using regression methods with multiply imputed data from the SMART Work & Life trial. Absenteeism, productivity and wellbeing measures were also evaluated. The average cost of SWAL-desk was £228.31 and SWAL-only £80.59 per office worker. Within the trial, SWAL-only was more effective and costly compared to control (incremental cost-effectiveness ratio (ICER): £12,091 per QALY) while SWAL-desk was dominated (least effective and most costly). However, over a lifetime horizon, both SWAL-only and SWAL-desk were more effective and more costly than control. Comparing SWAL-only to control generated an ICER of £4985 per QALY. SWAL-desk was more effective and costly than SWAL-only, generating an ICER of £13,378 per QALY. Findings were sensitive to various worker, intervention, and extrapolation-related factors. Based on a lifetime horizon, SWAL interventions appear cost-effective for office-workers conditional on worker characteristics, intervention cost and longer-term maintenance in sitting time reductions.

Original languageEnglish
Article number14861
JournalInternational Journal of Environmental Research and Public Health
Issue number22
Publication statusPublished - 11 Nov 2022

Keywords / Materials (for Non-textual outputs)

  • Humans
  • Sitting Position
  • Cost-Benefit Analysis
  • Quality-Adjusted Life Years
  • Absenteeism


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