Abstract
BackgroundDespite the known benefits of healthy eating in childhood, few Australian childcare services provide food that is consistent with dietary guidelines. The effectiveness of a web-based menu planning intervention to increase childcare service provision of healthy foods and decrease provision of discretionary foods in long day-care services in Australia was assessed in a randomised controlled trial. Here we consider the costs, consequences, cost-effectiveness and budget impact of the intervention using data collected within the trial.MethodsThe prospective trial-based economic evaluation involved 54 childcare services across New South Wales (NSW), Australia. Services were randomised to a 12-month intervention or usual care. The intervention involved access to a web-based menu planning and decision support tool and online resources. Effectiveness measures included mean number of food groups, overall menu and individual food group compliance with dietary guidelines, and mean servings of food groups at 12 months. Costs (reported in $AUD, 2017/18) were evaluated from both health sector and societal perspectives. The direct cost to support uptake of the intervention was calculated, as were costs to each childcare service. The incremental cost of the intervention was calculated as the net difference in the cost to undertake menu planning and review plus the direct cost of the intervention. Incremental cost-effectiveness ratios (ICERs) including uncertainty intervals were estimated for differences in costs and effects between intervention and control groups. A relative value index was calculated to determine overall value for money.ResultsOver the 12 months of the trial, we calculated a difference in cost between usual practice and intervention groups of − $482 (95% UI − $859, − $56). While the measured increase in menu and food group compliance within the trial did not reach statistical significance, there were significant improvements in mean servings of fruit and discretionary food, represented in the cost-consequence analysis. The calculated relative value index of 1.1 suggests that the intervention returns acceptable value for money for the outcomes generated.ConclusionCompared to usual practice, web-based programmes may offer an efficient and sustainable alternative for childcare services to improve the provision of healthy foods to children in their care.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12616000974404
Highlights
Despite the known benefits of healthy eating in childhood, few Australian childcare services provide food that is consistent with dietary guidelines
Compared to usual practice, web-based programmes may offer an efficient and sustainable alternative for childcare services to improve the provision of healthy foods to children in their care
Compared to usual practice services, intervention services achieved a non-significant increase in the primary outcome; the mean number of food groups on the menu that were compliant with dietary guidelines
Summary
Despite the known benefits of healthy eating in childhood, few Australian childcare services provide food that is consistent with dietary guidelines. In 2016, the WHO estimated the number of overweight children under the age of five to be over 41 million [2]. An Australian study estimated the direct healthcare costs of children with obesity aged 2–4 years to be 1.62 (95% CI 1.12–2.34, p = 0.01) times those of healthy weight children [4, 5]. The annual direct costs to the Australian healthcare system of early childhood obesity was calculated to be around $18 million ($2018 AUD) [4]. Two paediatric simulation studies in Germany [6, 7] considered the economic impact of childhood overweight and obesity, estimating total lifetime costs of €1.8 billion (2010) for the current prevalent population
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