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Randomized Controlled Trial
. 2017 Feb 21;12(2):e0172332.
doi: 10.1371/journal.pone.0172332. eCollection 2017.

Costs and effects of a state-wide health promotion program in primary schools in Germany - the Baden-Württemberg Study: A cluster-randomized, controlled trial

Dorothea Kesztyüs  1   2 , Romy Lauer  1 , Tibor Kesztyüs  3 , Reinhold Kilian  4 , Jürgen M Steinacker  1 ; “Join the Healthy Boat” Study Group
Affiliations
Randomized Controlled Trial

Costs and effects of a state-wide health promotion program in primary schools in Germany - the Baden-Württemberg Study: A cluster-randomized, controlled trial

Dorothea Kesztyüs et al. PLoS One. .

Abstract

Aim: To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program "Join the Healthy Boat" in primary schools in Germany.

Methods: Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated.

Results: The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group.

Conclusion: This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases.

Trial registration: German Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: DRKS00000494.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of enrollment, baseline measurements, and follow-up of teachers, classes and schools in the Baden-Württemberg Study.
Adapted from “Evaluation of a health promotion program in children: Study protocol and design of the cluster-randomized Baden-Wuerttemberg primary school study [DRKS-ID: DRKS00000494].,” by Dreyhaupt J, Koch B, Wirt T, Schreiber A, Brandstetter S, Kesztyues D, et al. BMC Public Health. 2012;12(1):157. Copyright 2012 by Dr. Jens Dreyhaupt. Adapted with permission.
Fig 2
Fig 2. Flowchart of participants/datasets in the Baden-Württemberg Study.
See this image and copyright information in PMC

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