Lifetime cost-effectiveness and equity impacts of the Healthy Primary School of the Future initiative
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RESEARCH ARTICLE
Open Access
Lifetime cost-effectiveness and equity impacts of the Healthy Primary School of the Future initiative Marije Oosterhoff1* , Eelco A. B. Over2, Anoukh van Giessen2, Rudolf T. Hoogenveen3, Hans Bosma4, Onno C. P. van Schayck5 and Manuela A. Joore1
Abstract Background: 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). Methods: The 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. Results: HPSF 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. Conclusions: HPSF 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 registration: Clinicaltrials.gov (NCT02800616). Registered 15 June 2016 – Retrospectively registered. Keywords: Cost-effectiveness, Health impact modelling, Lifestyle prevention, Childhood obesity
* Correspondence: [email protected] 1 Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center MUMC+/ Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included i
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