Abstract
BackgroundThis study estimated the lifetime cost-effectiveness and equity impacts associated with two lifestyle interventions in the Dutch primary school setting (targeting 4–12 year olds).MethodsThe Healthy Primary School of the Future (HPSF; a healthy school lunch and structured physical activity) and the Physical Activity School (PAS; structured physical activity) were compared to the regular Dutch curriculum (N = 1676). An adolescence model, calculating weight development, and the RIVM Chronic Disease Model, calculating overweight-related chronic diseases, were linked to estimate the lifetime impact on chronic diseases, quality adjusted life years (QALYs), healthcare, and productivity costs. Cost-effectiveness was expressed as the additional costs/QALY gained and we used €20,000 as threshold. Scenario analyses accounted for alternative effect maintenance scenarios and equity analyses examined cost-effectiveness in different socioeconomic status (SES) groups.ResultsHPSF resulted in a lifetime costs of €773 (societal perspective) and a lifetime QALY gain of 0.039 per child versus control schools. HPSF led to lower costs and more QALYs as compared to PAS. From a societal perspective, HPSF had a cost/QALY gained of €19,734 versus control schools, 50% probability of being cost-effective, and beneficial equity impact (0.02 QALYs gained/child for low versus high SES). The cost-effectiveness threshold was surpassed when intervention effects decayed over time.ConclusionsHPSF may be a cost-effective and equitable strategy for combatting the lifetime burden of unhealthy lifestyles. The win-win situation will, however, only be realised if the intervention effect is sustained into adulthood for all SES groups.Trial registrationClinicaltrials.gov (NCT02800616). Registered 15 June 2016 – Retrospectively registered.
Highlights
This study estimated the lifetime cost-effectiveness and equity impacts associated with two lifestyle interventions in the Dutch primary school setting
The differences in disease numbers declined because individuals that were exposed to Healthy Primary School of the Future (HPSF) and Physical Activity School (PAS) lived longer and experienced chronic disease during these life years gained
The findings show that the future health and cost impacts of HPSF and PAS are greatly influenced by the in/ exclusion of productivity costs (1), and the assumptions pertaining to the maintenance of the intervention effect (2)
Summary
This study estimated the lifetime cost-effectiveness and equity impacts associated with two lifestyle interventions in the Dutch primary school setting (targeting 4–12 year olds). Before 1990, less than 35% of Dutch adults were overweight or obese, which has increased to more than 50% in 2018 [3] This trend is burdensome, because excess weight is a risk factor for (early) development of chronic diseases and concomitant quality of life losses, premature death, and costs [4,5,6,7]. There is a high need for interventions that reduce (or at least do not widen) the disparities in health outcomes between people with a high and low socioeconomic position. It seems that lifestyle interventions can either increase or decrease health inequities between different socioeconomic groups [13, 14]. Cost-effectiveness estimates for different socioeconomic status (SES) groups can be used to inform these potential trade-offs [15]
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