Food, Health & Choices (FHC): Using Cost-Effectiveness Analysis (CEA) to Determine if Scaling Up is a Wise Investment

Abstract

ObjectiveCEA is useful when advocating to policymakers for scale-up of effective childhood obesity prevention interventions. This study assesses the cost-effectiveness of FHC, an effective 24-lesson science-based obesity prevention curriculum.Design, Setting and ParticipantsA CEA was conducted from a societal perspective with a no-intervention comparator. For this analysis, FHC implementation was modeled as if the entire population of New York City (NYC) fifth grade public school students (76,778) received the curriculum for one year.Outcome Measures and AnalysisThe CEA included costs of implementation, administration, and future medical costs of adult obesity. Effectiveness of the FHC intervention at age ten was based on obesity reductions from a randomized-controlled trial in twenty NYC public schools (boys 4% decrease with curriculum vs. 1.3% increase in control; girls 2.4% decrease with curriculum vs. 1.4% decrease in control). Projected adulthood obesity was based on published longitudinal studies. The Medical Expenditure Panel Survey (MEPS) provided estimations of direct medical costs for obese adults. To account for investment risk, a 3% discount was applied to future costs and effectiveness.ResultsFor this population, FHC costs $7,988,000 ($104/student/year). Implementation would result in 1263 fewer men and 131 fewer women becoming obese as adults, saving 6,497 quality-adjusted life years (QALY) and averting $16,218,000 in direct medical costs (2015 dollars). Base-case results of the CEA determined intervention costs of $4,540/QALY (95% confidence interval: $3,600 - $12,000/QALY).Conclusions and ImplicationsThe FHC curriculum is well below the $30,000/QALY threshold and thus cost effective. It is warranted to advocate for scale-up of FHC to fifth grade students.FundingUSDA. ObjectiveCEA is useful when advocating to policymakers for scale-up of effective childhood obesity prevention interventions. This study assesses the cost-effectiveness of FHC, an effective 24-lesson science-based obesity prevention curriculum. CEA is useful when advocating to policymakers for scale-up of effective childhood obesity prevention interventions. This study assesses the cost-effectiveness of FHC, an effective 24-lesson science-based obesity prevention curriculum. Design, Setting and ParticipantsA CEA was conducted from a societal perspective with a no-intervention comparator. For this analysis, FHC implementation was modeled as if the entire population of New York City (NYC) fifth grade public school students (76,778) received the curriculum for one year. A CEA was conducted from a societal perspective with a no-intervention comparator. For this analysis, FHC implementation was modeled as if the entire population of New York City (NYC) fifth grade public school students (76,778) received the curriculum for one year. Outcome Measures and AnalysisThe CEA included costs of implementation, administration, and future medical costs of adult obesity. Effectiveness of the FHC intervention at age ten was based on obesity reductions from a randomized-controlled trial in twenty NYC public schools (boys 4% decrease with curriculum vs. 1.3% increase in control; girls 2.4% decrease with curriculum vs. 1.4% decrease in control). Projected adulthood obesity was based on published longitudinal studies. The Medical Expenditure Panel Survey (MEPS) provided estimations of direct medical costs for obese adults. To account for investment risk, a 3% discount was applied to future costs and effectiveness. The CEA included costs of implementation, administration, and future medical costs of adult obesity. Effectiveness of the FHC intervention at age ten was based on obesity reductions from a randomized-controlled trial in twenty NYC public schools (boys 4% decrease with curriculum vs. 1.3% increase in control; girls 2.4% decrease with curriculum vs. 1.4% decrease in control). Projected adulthood obesity was based on published longitudinal studies. The Medical Expenditure Panel Survey (MEPS) provided estimations of direct medical costs for obese adults. To account for investment risk, a 3% discount was applied to future costs and effectiveness. ResultsFor this population, FHC costs $7,988,000 ($104/student/year). Implementation would result in 1263 fewer men and 131 fewer women becoming obese as adults, saving 6,497 quality-adjusted life years (QALY) and averting $16,218,000 in direct medical costs (2015 dollars). Base-case results of the CEA determined intervention costs of $4,540/QALY (95% confidence interval: $3,600 - $12,000/QALY). For this population, FHC costs $7,988,000 ($104/student/year). Implementation would result in 1263 fewer men and 131 fewer women becoming obese as adults, saving 6,497 quality-adjusted life years (QALY) and averting $16,218,000 in direct medical costs (2015 dollars). Base-case results of the CEA determined intervention costs of $4,540/QALY (95% confidence interval: $3,600 - $12,000/QALY). Conclusions and ImplicationsThe FHC curriculum is well below the $30,000/QALY threshold and thus cost effective. It is warranted to advocate for scale-up of FHC to fifth grade students. The FHC curriculum is well below the $30,000/QALY threshold and thus cost effective. It is warranted to advocate for scale-up of FHC to fifth grade students.