Abstract
The SWAP IT program aims to improve the nutritional quality of school lunchboxes via a multicomponent m-health intervention, involving: weekly support messages to parents; physical resources; school nutrition guidelines and lunchbox lessons. SWAP IT has been reported to be effective. This study aims to determine the cost and cost effectiveness of the SWAP IT m-health intervention. The retrospective trial-based economic evaluation was conducted in 12 Catholic primary schools in New South Wales, Australia. Schools were randomised to intervention or usual care. The costs (AUD, 2019) were evaluated from societal perspectives. The direct cost to uptake the intervention and the incremental cost-effectiveness ratios (ICER) were calculated. ICERS were calculated for two outcomes: reduction in total kJ and reduction in discretionary kJ from the lunchbox. The total cost was calculated to be AUD 55, 467. The mean incremental cost per student to receive the intervention was calculated to be AUD 31/student. The cost per reduction in total lunchbox energy was AUD 0.54. The ICER for the reduction in energy from discretionary foods in the lunchbox was AUD 0.24. These findings suggest that this m-health intervention has potential to be cost effective in reducing the kilojoules from discretionary foods packed in school lunchboxes.
Highlights
Childhood overweight and obesity is a major public health concern
The study was conducted as part of a broader 2 × 2 factorial cluster randomized controlled trial, which tested the efficacy, feasibility and acceptability of two interventions: (1) physical activity intervention to support primary schools in increasing moderate and some vigorous physical activity across the school week [26] and (2) a lunchbox intervention to support parents in improving the nutritional quality of primary school lunchboxes [18]
This is the first study internationally to assess the cost and cost effectiveness of an. This is the first study internationally to assess the cost and cost effectiveness of an mm-health lunchbox intervention, which aimed to improve the nutritional quality of foods health lunchbox intervention, which aimed to improve the nutritional quality of foods packed in children’s school lunchboxes
Summary
Childhood overweight and obesity is a major public health concern. Childhood overweight and obesity has adverse health, social and educational impacts, including a higher risk of chronic disease in later life [2], low self-esteem [3] and lower academic performance [2]. It has been estimated that the incremental lifetime per capita cost of childhood obesity in the USA is USD 19,630 compared to a child at a healthy weight, at USD 12,660 [4]. In 2018/19, the cost of childhood obesity in England was estimated at GBP 61.7 million [5]. In Australia, the additional annual medical costs associated with childhood overweight and obesity is estimated to be AUD 43 million [6]
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