Economic Evaluation of URMEL-ICE, a School-based Overweight Prevention Program Comprising Metabolism, Exercise and Lifestyle Intervention

Abstract

PURPOSE: Evaluation of the impact of the URMEL-ICE school-based overweight prevention program on anthropometric measures in primary school children. To analyse whether the economic evaluation of the intervention shows a favorable incremental cost effectiveness relation (ICER) and positive net monetary benefit (NMB). METHODS: Intervention study with historical control. Propensity Score method to handle missing randomisation. Anthropometric measurements were made in 343 children in the control and 346 children in the intervention group at baseline and at one year follow up. Teachers completed questionnaires on time spent preparing the lessons. The effectiveness of the intervention was measured as cm waist circumference (WC), and unit (0.01) waist to height ratio (WHTR) increase prevented in intervention vs. control, using a multilevel model with adjustment for baseline value and propensity score. Standard cost-effectiveness analysis methods and a societal perspective were used in this health economics research for a one year time horizon. Program delivery costs include personnel costs of the scientific coordinator ensuring training and support for the teachers and costs of working hours of the teachers preparing the lessons and material expenses. All costs were assessed in 2008 units. RESULTS: WC gain was 1.61cm and WHTR gain 0.014 less in the intervention than in the control group (p<0.05). Total intervention costs add up to US$35.69 per child. The ICER was US$16.33 (95%KI [12.85; 22.24]) per cm WC and US$28.84 (95%KI [21.30; 44.00]) per unit WHTR gain prevented. NMB was positive for a maximum willingness to pay (MWTP) of US$16.3 (95%KI [12.83; 22.26]) for WC and US$28.84 (95%KI [20.58; 44.01]) for 0.01 WHTR. CONCLUSIONS: Assuming a MWTP greater than US$16.33 the intervention is cost-effective with a positive NMB. This result may help decision makers in implementing programs to prevent childhood overweight in a school setting.