Abstract
BackgroundFew school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent populations. As a result, few cost effectiveness analyses have been reported. The aim of this paper is to report the cost and cost effectiveness of the Physical Activity 4 Everyone (PA4E1) intervention which was a multi-component intervention implemented in secondary schools located in low-income communities. Cost effectiveness was assessed using both the physical activity and weight status trial outcomes.MethodsIntervention and Study Design: The PA4E1 cluster randomised controlled trial was implemented in 10 Australian secondary schools (5 intervention: 5 control) and consisted of intervention schools receiving seven physical activity promotion strategies and six additional strategies that supported school implementation of the intervention components. Costs associated with physical activity strategies, and intervention implementation strategies within the five intervention schools were estimated and compared to the costs of usual physical activity practices of schools in the control group. The total cost of implementing the intervention was estimated from a societal perspective, based on the number of enrolled students in the target grade at the start of the intervention (Grade 7, n = 837).Economic Outcomes: The economic analysis outcomes were cost and incremental cost effectiveness ratios for the following: minutes of moderate-to-vigorous physical activity (MVPA) per day gained, MET hours gained per person/day; Body Mass Index (BMI) unit avoided; and 10 % reduction in BMI z-score.ResultsThe intervention cost AUD $329,952 over 24 months, or AUD$394 per student in the intervention group. This resulted in a cost effectiveness ratio of AUD$56 ($35–$147) per additional minute of MVPA, AUD$1 ($0.6–$2.7) per MET hour gained per person per day, AUD$1408 ($788–$6,570) per BMI unit avoided, and AUD$563 ($282–$3,942) per 10 % reduction in BMI z-score.ConclusionPA4E1 is a cost effective intervention for increasing the physical activity levels and reducing unhealthy weight gain in adolescence, a period in which physical activity typically declines. Additional modelling could explore the potential economic impact of the intervention on morbidity and mortality.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612000382875.
Highlights
Few school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent populations
Due to the limited literature outlining the cost effectiveness of school-based interventions that can impact on both physical activity and weight status in adolescents, the aim of this study was to assess the costs of the Physical activity 4 everyone (PA4E1) intervention, and the cost effectiveness of the intervention considering both physical activity and weight status trial outcomes
Cost per MET hour gained per person per day: When mean minutes moderate-to-vigorous physical activity (MVPA) per day were converted to MET hours gained, the PA4E1 intervention resulted in 0.5 [95 % CI 0.2–0.9] MET hours gained per person/ day, and a cost of effectiveness ratio of $1 ($0.6–$2.7 per MET hour gained (Table 3)
Summary
Few school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent populations. The large proportion of low-active adolescents, coupled with the global concern regarding overweight and obesity, make population-based interventions focused on physical activity promotion and obesity prevention in this population sub-group a public health priority [6,7,8]. As both physical inactivity and overweight and obesity are more prevalent in adolescents from disadvantaged backgrounds, strategies targeting this population are warranted [9, 10]. A recent systematic review reported only 14 of the 44 included schoolbased physical activity intervention trials targeted adolescents, of which only four resulted in significant physical activity intervention effects [7]. Systematic reviews of interventions that aim to prevent obesity have demonstrated smaller effects in adolescent populations in comparison to younger children [22]
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