Economic Evaluation of a Community‐based Obesity Prevention Program in Children: The APPLE Project

Abstract

Effective strategies are urgently required to reduce the prevalence of obesity during growth. Determining which strategies are most successful should also include analysis of their relative costs. To date, few obesity prevention studies in children have reported data concerning cost-effectiveness. The aim of this study was to assess the costs and health benefits of implementing the APPLE (A Pilot Program for Lifestyle and Exercise) project, a 2-year controlled community-based obesity prevention initiative utilizing activity coordinators (ACs) in schools and nutrition promotion in New Zealand children (5-12 years). The marginal costs of the project in 2006 prices were estimated and compared with the kilograms (kg) of weight-gain prevented for children in the intervention relative to the control arm. The children's health-related quality of life (HRQoL) was also measured using the Health Utilities Index (HUI). The total project cost was NZ$357,490, or NZ$1,281 per intervention child for 2 years (NZ$1 = US$0.67 = UK pound 0.35 = EUR euro 0.52). Weight z-score was reduced by 0.18 (0.13, 0.22) units at 2 years and 0.17 (0.11, 0.23) units at 4 years in intervention relative to control children. Mean HUI values did not differ between intervention and control participants. The reduction in weight z-score observed is equivalent to 2.0 kg of weight-gain prevented at 15 years of age. The relatively simple intervention approach employed by the APPLE project was successful in significantly reducing the rate of excessive weight gain in children, with implementation costs of NZ$664-1,708 per kg of weight-gain prevented over 4 years.

Role of Developmental Overnutrition in Pediatric Obesity and Type 2 Diabetes

“…The present study is the first to follow a life course approach for the purpose of quantifying the impact on adulthood obesity of school-based promotion of healthy eating and active living. Our findings are consistent with the existing evidence that interventions at an early age are effective in influencing body weight status later in life and that school-based prevention programs may therefore be cost effective [5,[20][21][22][23][24][25][26]. In the United States, Wang et al developed a progression model to project the long-term benefits of a school based intervention and reported a 1% reduction in overweight and obese and $586 million in cost savings [27].…”

Prävention und Therapie von Übergewicht und Adipositas im Kindes- und Jugendalter aus gesundheitsökonomischer Sicht

“…Sieben gesundheitsökonomische Evaluationsstudien, darunter zwei KEA [36,37] und fünf KUA [38,39,40,41,42] Intervention war nicht kosteneffektiv: führte im Vergleich zum Komparator zu zusätzlichen Interventionskosten von 899 USD pro Familie bei nicht signifikant schlechteren gesundheitlichen Effekten. Je 1000 USD bewirkte die Intervention circa −0,4 BMI-Z-Score-Einheiten, der Komparator circa −1,0 BMI-Z-Score-Einheiten weils mit dem Status quo (keine Intervention) verglichen.…”

“…In sechs Studien wurden schulbasierte Programme für Kinder im Alter zwischen fünf und zwölf Jahren in den USA [37,41,42], Australien [38,40] und Neuseeland [36] …”

“…Beide Programme erwiesen sich jedoch mit einer IKER von 82.000 Australischen Dollar (AUD) pro vermiedenem DALY beziehungsweise 760.000 AUD pro vermiedenem DALY als nicht kosteneffektiv. Deutlich günstigere IKER fanden sich bei vier Studien, in denen multifaktorielle Ansät-ze untersucht wurden[36,37,41,42]. Bei den in diesen Studien evaluierten Interventionen wurden verschiedene Maßnah-men zur Steigerung der körperlichen Aktivität (zum Beispiel Wissensvermittlung und Veränderung der Schulspeisung) kombiniert.…”

Preliminary assessment of a school-based healthy lifestyle program among rural children.

“…Wang et al, 2003). This societal method has been widely used to assess the cost-effectiveness of school-based healthy lifestyle programs (H. S. Brown et al, 2007;McAuley et al, 2010).…”