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Abstract
BackgroundTo assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB) program for Australian primary school children as an obesity prevention measure. The intervention was modelled as part of the ACE-Obesity study, which evaluated, using consistent methods, thirteen interventions targeting unhealthy weight gain in Australian children and adolescents.MethodsA logic pathway was used to model the effects on body mass index [BMI] and disability-adjusted life years [DALYs] of the Victorian WSB program if applied throughout Australia. Cost offsets and DALY benefits were modelled until the eligible cohort reached 100 years of age or death. The reference year was 2001. Second stage filter criteria ('equity', 'strength of evidence', 'acceptability', feasibility', sustainability' and 'side-effects') were assessed to incorporate additional factors that impact on resource allocation decisions.ResultsThe modelled intervention reached 7,840 children aged 5 to 7 years and cost $AUD22.8M ($16.6M; $30.9M). This resulted in an incremental saving of 30 DALYs (7:104) and a net cost per DALY saved of $AUD0.76M ($0.23M; $3.32M). The evidence base was judged as 'weak' as there are no data available documenting the increase in the number of children walking due to the intervention. The high costs of the current approach may limit sustainability.ConclusionUnder current modelling assumptions, the WSB program is not an effective or cost-effective measure to reduce childhood obesity. The attribution of some costs to non-obesity objectives (reduced traffic congestion and air pollution etc.) is justified to emphasise the other possible benefits. The program's cost-effectiveness would be improved by more comprehensive implementation within current infrastructure arrangements. The importance of active transport to school suggests that improvements in WSB or its variants need to be developed and fully evaluated.
Highlights
To assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB) program for Australian primary school children as an obesity prevention measure
A range of other available data was used to model the likely change in the Body Mass Index (BMI) of individual participants of the WSB program who were new to active transport (Table 1)
Incremental cost-effectiveness The incremental effect of the WSB intervention was a reduction of 0.03 (95%UI 0.01; 0.11) BMI units per child taking up walking to school (Table 3)
Summary
To assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB) program for Australian primary school children as an obesity prevention measure. While the majority of Australian primary school children in urban environments live within walking and cycling distance to school [2], there are a number of real and perceived barriers which contribute to the continued decline in active transport rates. The increasing participation of women in the workforce adds time pressure to family living [4] and potentially contributes to declining active transport rates In countries such as The Netherlands and Germany, where there is a culture of active transport and compulsory education programs for children around active transport and traffic safety, participation rates are much higher and obesity, diabetes and hypertension rates (in adults) are much lower than the USA or Australia [5]. Government strategies in The Netherlands and Germany to increase active transport and improve safety have seen fatalities decline markedly between 1975 and 2001 and urban environments changed to improve conditions for active transport participants [5]
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