Abstract
A uniform approach for costing school-based lifestyle interventions is currently lacking. The objective of this study was to develop a template for costing primary school-based lifestyle interventions and apply this to the costing of the “Healthy Primary School of the Future” (HPSF) and the “Physical Activity School” (PAS), which aim to improve physical activity and dietary behaviors. Cost-effectiveness studies were reviewed to identify the cost items. Societal costs were reflected by summing up the education, household and leisure, labor and social security, and health perspectives. Cost inputs for HPSF and PAS were obtained for the first year after implementation. In a scenario analysis, the costs were explored for a hypothetical steady state. From a societal perspective, the per child costs were €2.7/$3.3 (HPSF) and €− 0.3/$− 0.4 (PAS) per day during the first year after implementation, and €1.0/$1.2 and €− 1.3/$− 1.6 in a steady state, respectively (2016 prices). The highest costs were incurred by the education perspective (first year: €8.7/$10.6 (HPSF) and €4.0/$4.9 (PAS); steady state: €6.1/$7.4 (HPSF) and €2.1/$2.6 (PAS)), whereas most of the cost offsets were received by the household and leisure perspective (first year: €− 6.0/$− 7.3 (HPSF) and €− 4.4/$− 5.4 (PAS); steady state: €− 5.0/$− 6.1 (HPSF) and €− 3.4/$− 4.1 (PAS)). The template proved helpful for costing HPSF and PAS from various stakeholder perspectives. The costs for the education sector were fully (PAS) and almost fully (HPSF) compensated by the savings within the household sector. Whether the additional costs of HPSF over PAS represent value for money will depend on their relative effectiveness.
Highlights
IntroductionA number of studies found that recent primary school-based lifestyle interventions are effective in normalizing children’s body mass index (BMI) (Mei et al 2016; Sobol-Goldberg, Rabinowitz, and Gross 2013)
It is increasingly being recognized that schools have a key role in the promotion of children’s health and wellbeing (HaymanElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.2016; Tang et al 2009)
Negative costs may come into play when the school day is extended or when interventions are offered during the after-school hours, which results in time being freed up for the primary caregiver of the child
Summary
A number of studies found that recent primary school-based lifestyle interventions are effective in normalizing children’s body mass index (BMI) (Mei et al 2016; Sobol-Goldberg, Rabinowitz, and Gross 2013). This study focuses on performing systematic and standardized cost calculations on school-based lifestyle interventions. The heterogeneity in costing approaches is, amongst others, reflected by the various methods for identifying and selecting cost items. While the recurring resource use of intervention delivery is generally included in cost calculations, a minority of studies included development and evaluation costs, and consensus on this aspect seems to be lacking (Meng et al 2013; Moodie et al 2013; Wang, Li, Siahpush, Chen, and Huberty 2017).
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