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Economic evaluation of URMEL-ICE, a school-based overweight prevention programme comprising metabolism, exercise and lifestyle intervention in children

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Abstract

Objective

Measuring the impact of the URMEL-ICE school-based overweight prevention programme on anthropometric measures in primary-school children, computing incremental cost-effectiveness relation (ICER) and net monetary benefit (NMB).

Methods

This is an intervention study with historical control. Propensity score method is applied to account for group differences. One-year teacher-driven classroom implementation is used, which is based on especially developed teaching material including health education, physical activity breaks and parent involvement. 354 children in the control and 365 children in the intervention group at baseline and follow-up were analysed. Effectiveness is measured as cm waist circumference (WC) and unit (0.01) waist-to-height ratio (WHtR) increase prevented in intervention vs. control group using an adjusted two-level model. Standard cost-effectiveness analysis methods, net benefit regression and a societal perspective for a 1-year time horizon are applied.

Results

WC gain was 1.61 cm and WHtR gain was 0.014 significantly less in intervention vs. control group. Intervention costs were €24.09 per child. ICER was €11.11 (95% confidence interval (CI) [8.78; 15.02]) per cm WC and €18.55 (95% CI [14.04; 26.86]) per unit WHtR gain prevented. At a maximum willingness to pay (MWTP) of €35, both values of the CIs for NMB regarding WC and WHtR are located in the positive range.

Conclusions

The study gives new information about the cost-effectiveness of structured health promotion embedded in daily routine at primary schools. Assuming a MWTP of €35 the intervention is cost-effective with a positive NMB. This result may help decision makers in implementing programmes to prevent childhood overweight in school settings.

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References

  1. Trasande, L.: How much should we invest in preventing childhood obesity? Health Aff. (Millwood) 29, 372–378 (2010)

    Article  Google Scholar 

  2. Daniels, S.R.: The consequences of childhood overweight and obesity. Future Child 16, 47–67 (2006)

    Article  PubMed  Google Scholar 

  3. Fry, J., Finley, W.: The prevalence and costs of obesity in the EU. Proc. Nutr. Soc. 64, 359–362 (2005)

    Article  PubMed  Google Scholar 

  4. Finkelstein, E.A., Ruhm, C.J., Kosa, K.M.: Economic causes and consequences of obesity. Annu. Rev. Public Health 26, 239–257 (2005)

    Article  PubMed  Google Scholar 

  5. Fröschl, B., Haas, S., Wirl, C.: Overweight prevention in adolescents and children (behavioural and environmental prevention). Cologne: German agency for health technology assessment (DAHTA). pp. 1–10. http://portal.dimdi.de/hta/hta_berichte/hta242_bericht_de.pdf (2009). Accessed 14 June 2011

  6. Schwappach, D.L.B.: The economic evaluation of prevention–let’s talk about values and the case of discounting. Int. J. Public Health 52, 335–336 (2007)

    Article  PubMed  Google Scholar 

  7. John, J., Wenig, C.M., Wolfenstetter, S.B.: Recent economic findings on childhood obesity: cost-of-illness and cost-effectiveness of interventions. Curr. Opin. Clin. Nutr. Metab. Care (2010). doi:10.1097/MCO.0b013e328337fe18

  8. Nething, K., Stroth, S., Wabitsch, M., Galm, C., Rapp, K., Brandstetter, S., Berg, S., Kresz, A., Wartha, O., Steinacker, J.M.: Primärprävention von Folgeerkrankungen des Übergewichts bei Kindern und Jugendlichen [Primary prevention of sequelae of adiposity in children and adolescents]. Dtsch. Z. Sportmed. 2, 42–45 (2006)

    Google Scholar 

  9. Nagel, G., Wabitsch, M., Galm, C., Berg, S., Brandstetter, S., Fritz, M., et al.: Determinants of obesity in the Ulm research on metabolism, exercise and lifestyle in children (URMEL-ICE). Eur. J. Pediatr. 168, 1259–1267 (2009)

    Article  PubMed  Google Scholar 

  10. Ebbeling, C.B., Pawlak, D.B., Ludwig, D.S.: Childhood obesity: public-health crisis, common sense cure. Lancet 360, 473–482 (2002)

    Article  PubMed  Google Scholar 

  11. World Health Organization. Obesity and overweight. WHO. http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf (2003). Accessed 14 June 2011

  12. Cole, T.J., Bellizzi, M.C., Flegal, K.M., Dietz, W.H.: Establishing a standard definition for child and obesity worldwide: international survey. BMJ 320, 1240–1243 (2000)

    Article  PubMed  CAS  Google Scholar 

  13. Schwandt, P., Kelishadi, R., Haas, G.M.: First reference curves of waist circumference for German children in comparison to international values: the PEP Family Heart STudy. World J. Pediatr. 4, 259–266 (2008)

    Article  PubMed  Google Scholar 

  14. D’Agostino, R.B.: Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat. Med. 17, 2265–2281 (1998)

    Article  PubMed  Google Scholar 

  15. Morshed, S., Tornetta, P., Bhandari, M.: Analysis of observational studies: a guide to understanding statistical methods. J. Bone Jt. Surg 91, 50–60 (2009)

    Article  Google Scholar 

  16. McAuley, K.A., Taylor, R.W., Farmer, V.L., Hansen, P., Williams, S.M., Booker, C.S., et al.: Economic evaluation of a community based obesity prevention program in children: the APPLE project. Obesity 18, 131–136 (2010)

    Article  PubMed  Google Scholar 

  17. Bayerisches Landesamt für Statistik und Datenverarbeitung. Volksschulen in Bayern [Elementary schools in Bavaria]. München: Bayerisches Landesamt für Statistik und Datenverarbeitung; LfStaD. http://www.statistik.bayern.de/veroeffentlichungen/?themenbereich=3200 (2009). Accessed 14 June 2011

  18. Landesamt für Finanzen. Besoldungstabellen Archiv [Salary tables archive]. http://www.lff.bayern.de/bezuege/besoldung/ (2009). Accessed 14 June 2011

  19. Glick, H.A., Doshi, J.A., Sonnad, S.S., Polsky, D.: Web resources. In: Gray, A., Briggs, A. (eds.) Economic evaluation in clinical trials, vol. 5 of Handbooks in Health Economic Evaluation Series, p. vii. Oxford University Press (2007)

  20. Kilian, R.: Gesundheitsökonomische Evaluation in der psychiatrischen Versorgungsforschung. [Health economic evaluation in mental health services research]. Präv. Gesundheitsf. 3, 135–144 (2008)

    Article  Google Scholar 

  21. Fenwick, E., Byfort, S.: A guide to cost-effectiveness acceptability curves. Br. J. Psychiatry 187, 106–108 (2005)

    Article  PubMed  Google Scholar 

  22. Hoch, J.S.: Improving efficiency and value in palliative care with net benefit regression: an introduction to a simple method for cost-effectiveness analysis with personal level data. J. Pain Symptom Manag. 38, 54–61 (2009)

    Article  Google Scholar 

  23. Indurkhya, A., Mitra, N., Schrag, D.: Using propensity scores to estimate the cost-effectiveness of medical therapies. Stat. Med. 25, 1561–1576 (2006)

    Article  PubMed  Google Scholar 

  24. Kropski, J.A., Keckley, P.H., Jensen, G.L.: School-based obesity prevention programs: an evidence-based review. Obesity (Silver Spring) 16, 1009–1018 (2008)

    Article  Google Scholar 

  25. Livingstone, M.B.E., McCaffrey, T.A., Rennie, K.L.: Childhood obesity prevention studies: lessons learned and to be learned. Public Health Nutr. 9, 1121–1129 (2006)

    Article  PubMed  CAS  Google Scholar 

  26. Wang, L.Y., Yang, Q., Lowry, R., Wechsler, H.: Economic analysis of a school-based obesity prevention program. Obes. Res. 11, 1313–1324 (2003)

    Article  PubMed  Google Scholar 

  27. Cawley, J.: Contingent valuation analysis of willingness to pay to reduce childhood obesity. Econ. Hum. Biol. 6, 281–292 (2008)

    Article  PubMed  Google Scholar 

  28. Prosser, L.A., Hammitt, J.K., Keren, R.: Measuring health preferences for use in cost-utility and cost-benefit analyses of interventions in children: theoretical and methodological considerations. Pharmacoeconomics 25, 713–726 (2007)

    Article  PubMed  Google Scholar 

  29. Tarride, J.E., Burke, N., Bischof, M., Hopkins, R.B., Goeree, L., Campbell, K., et al.: A review of health utilities across conditions common in paediatric and adult populations. Health Qual. Life Outcomes. 8, 12 (2010)

    Google Scholar 

  30. Williams, J., Wake, M., Hesketh, K., Maher, E., Waters, E.: Health-related quality of life of overweight and obese children. JAMA. 293, 70–76 (2005)

    Article  PubMed  CAS  Google Scholar 

  31. Wille, N., Erhart, M., Petersen, C., Ravens-Sieberer, U.: The impact of overweight and obesity on health-related quality of life in childhoodresults from an intervention study. BMC. Public Health. 8, 421 (2008)

    Google Scholar 

  32. Wake, M., Salmon, L., Waters, E., Wright, M., Hesketh, K.: Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey. Int. J. Obes. Relat. Metab. Disord. 26, 717–724 (2002)

    Article  PubMed  CAS  Google Scholar 

  33. Rodríguez, G., Moreno, L.A., Blay, M.G., Blay, V.A., Garagorri, J.M., Sarría, A., et al.: Body composition in adolescents: measurements and metabolic aspects. Int. J. Obes. Relat. Metab. Disord. 28, S54–S58 (2004)

    Article  PubMed  Google Scholar 

  34. Schneider, H.J., Friedrich, N., Klotsche, J., Pieper, L., Nauck, M., John, U., et al.: The predictive value of different measures of obesity for incident cardiovascular events and mortality. J. Clin. Endocrinol. Metab. 95, 1777–1785 (2010)

    Article  PubMed  CAS  Google Scholar 

  35. Zimmet, P., Alberti, G., Kaufman, F., Tajima, N., Silink, M., Arslanian, S., et al.: The metabolic syndrome in children and adolescents. Lancet 369, 2059–2061 (2007)

    Article  PubMed  Google Scholar 

  36. Maffeis, C., Pietrobelli, A., Gressani, A., Provera, S., Tatò, L.: Waist circumference and cardiovascular risk factors in prepubertal children. Obes. Res. 9, 179–187 (2001)

    Article  PubMed  CAS  Google Scholar 

  37. Maffeis, C., Grezzani, A., Pietrobelli, A., Provera, S., Tatò, L.: Does waist circumference predict fat gain in children? Int. J. Obes. Relat. Metab. Disord. 25, 978–983 (2001)

    Article  CAS  Google Scholar 

  38. Ashwell, M., Hsieh, S.D.: Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int. J. Food Sci. Nutr. 56, 303–307 (2005)

    Article  PubMed  Google Scholar 

  39. Kahn, H., Imperatore, G., Cheng, Y.J.: A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth. J. Pediatr. 146, 482–488 (2005)

    Article  PubMed  Google Scholar 

  40. Savva, S.C., Tornaritis, M., Savva, M.E., Kourides, Y., Panagi, A., Silikiotou, N., et al.: Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int. J. Obes. Relat. Metab. Disord. 24, 1453–1458 (2000)

    Article  PubMed  CAS  Google Scholar 

  41. Mokha, J.S., Srinivasan, S.R., Dasmahaptra, P., Fernandez, C., Chen, W., Xu, J., et al.: Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC. Pediatr. 10, 73 (2010)

    Google Scholar 

  42. Cornier, M.A., Tate, C.W., Grundwald, G.K., Bessesen, D.H.: Relationship between waist circumference, body mass index, and medical care costs. Obes. Res. 10, 1167–1172 (2002)

    Article  PubMed  Google Scholar 

  43. Højgaard, B., Gryd-Hansen, D., Olsen, K.R., Søgaard, J., Sørensen, T.I.A.: Waist circumference and body mass index as predictors of health care costs. PLoS One. 3, e2619 (2008)

  44. Højgaard, B., Olsen, K.R., Søgaard, J., Sørensen, T.I.A., Gryd-Hansen, D.: Economic costs of abdominal obesity. Obes. Facts. 1, 146–154 (2008)

    Article  PubMed  Google Scholar 

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Acknowledgments

URMEL-ICE Ulm was funded by the Baden-Württemberg Stiftung, and URMEL-ICE Günzburg was funded by the county of Günzburg and the community foundation of the county. We like to thank all who supported the URMEL-ICE Günzburg project, namely the district administrator H. Hafner and his staff members from the district administration, Dr. Dr. W. Stolle and the members of the community foundation, Dr. R. Schmid from the medical authority, H. Hillenbrand from the AOK Günzburg, and J. Seibold from the local education authority. Many thanks for their contributions to B. Aigner and the students of the school of physiotherapy in Günzburg. Special thanks to S. Sufeida for the data management. Thanks to all members of the “Komm mit in das Gesunde Boot–Grundschule” working group for their input. Thanks to all members of the former URMEL-ICE working group. Thanks to V. and C. Friedl for their language assistance. Finally, we thank the teachers and pupils who participated in the study.

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Authors and Affiliations

  1. Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075, Ulm, Germany

    Dorothea Kesztyüs, Anja Schreiber, Tamara Wirt, Susanne Brandstetter, Benjamin Koch, Olivia Wartha & Jürgen M. Steinacker

  2. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany

    Martina Wiedom, Jens Dreyhaupt & Rainer Muche

  3. Medical Sociology, Institute of Epidemiology and Preventive Medicine, Regensburg University, Regensburg, Germany

    Susanne Brandstetter

  4. Transfer Centre for Neuroscience and Learning (ZNL), University of Ulm, Ulm, Germany

    Olivia Wartha

  5. Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Ulm University Medical Centre, Ulm, Germany

    Martin Wabitsch

  6. Research - Mental Health Services RU, Department of Psychiatry II, Ulm University, Günzburg, Germany

    Reinhold Kilian

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  1. Dorothea Kesztyüs
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Correspondence to Dorothea Kesztyüs.

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Kesztyüs, D., Schreiber, A., Wirt, T. et al. Economic evaluation of URMEL-ICE, a school-based overweight prevention programme comprising metabolism, exercise and lifestyle intervention in children. Eur J Health Econ 14, 185–195 (2013). https://doi.org/10.1007/s10198-011-0358-3

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  • DOI: https://doi.org/10.1007/s10198-011-0358-3

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