Economic evaluation of a community-based obesity prevention program in children: the APPLE project

Abstract

Effective strategies are urgently required to reduce the prevalence of obesity during growth. Determining which strategies are most successful should also include analysis of their relative costs. To date, few obesity prevention studies in children have reported data concerning cost-effectiveness. The aim of this study was to assess the costs and health benefits of implementing the APPLE (A Pilot Program for Lifestyle and Exercise) project, a 2-year controlled community-based obesity prevention initiative utilizing activity coordinators (ACs) in schools and nutrition promotion in New Zealand children (5-12 years). The marginal costs of the project in 2006 prices were estimated and compared with the kilograms (kg) of weight-gain prevented for children in the intervention relative to the control arm. The children's health-related quality of life (HRQoL) was also measured using the Health Utilities Index (HUI). The total project cost was NZ$357,490, or NZ$1,281 per intervention child for 2 years (NZ$1 = US$0.67 = UK pound 0.35 = EUR euro 0.52). Weight z-score was reduced by 0.18 (0.13, 0.22) units at 2 years and 0.17 (0.11, 0.23) units at 4 years in intervention relative to control children. Mean HUI values did not differ between intervention and control participants. The reduction in weight z-score observed is equivalent to 2.0 kg of weight-gain prevented at 15 years of age. The relatively simple intervention approach employed by the APPLE project was successful in significantly reducing the rate of excessive weight gain in children, with implementation costs of NZ$664-1,708 per kg of weight-gain prevented over 4 years.