Prevention Science

, Volume 20, Issue 5, pp 655–664 | Cite as

Costs of Preparing to Implement a Family-Based Intervention to Prevent Pediatric Obesity in Primary Care: a Budget Impact Analysis

  • Neil Jordan
  • Andrea K. Graham
  • Cady Berkel
  • Justin D. SmithEmail author


The costs associated with implementing evidence-based programs for pediatric obesity contribute to a lack of widespread adoption. This study examined the costs of preparing to implement the Family Check-Up 4 Health (FCU4Health), a family-centered behavioral program for the prevention of pediatric obesity and excess weight gain in primary care. Budget impact analysis was used to estimate the cost of preparing to implement FCU4Health (i.e., the activities to prepare for, but prior to, offering the service to families). Electronic cost capture methods were used to prospectively track personnel time associated with implementation preparation activities. We also estimated the cost of replicating these preparatory activities to inform future decisions to adopt the program and associated budgetary planning. The total cost of FCU4Health implementation preparation in three clinics and developing delivery materials and infrastructure was $181,768, for an average of $60,589 per clinic. Over two thirds of the total cost were personnel related, the largest of which was associated with the time spent developing automated fidelity coding for monitoring (20%), developing and tailoring clinical materials (16%), and training FCU4Health coordinators (15%). Due to these development costs associated with an initial implementation, that we anticipate would not be repeated in full, we estimated the cost to prepare FCU4Health for implementation in a future initiative will range from $15,195 to $17,912 per clinic. This study is a critical step towards equipping decision-makers with comprehensive short-term information about expected costs that are incurred immediately after choosing to adopt an evidence-based program.


Budget impact analysis Family Check-Up 4 Health Implementation cost Health economics Primary care 



National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (U18 DP006255; Berkel & Smith), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F32 HD089586; Graham).

Compliance with Ethical Standards

Conflict of Interest

JDS and CB co-developed the Family Check-Up 4 Health program with Thomas Dishion, the developer of the original Family Check-Up.

Ethical Approval

This trial was designed in accordance with the basic ethical principles of autonomy, beneficence, justice, and non-maleficence and will be conducted in accordance with the rules of Good Clinical Practice outlined in the most recent Declaration of Helsinki. Data confidentiality and anonymity will be ensured. The project was approved by the Institutional Review Boards of Arizona State University (Protocol 00004530) and the Phoenix Children’s Hospital (Protocol 17-001). All other institutions participating in this research provided signed reliance agreements ceding to the Institutional Review Board of Arizona State University. Any important protocol modification will be communicated to the Institutional Review Board of Arizona State University and updated in

Informed Consent

Informed consent was not required for this aspect of the study as the data sources are administrative.


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Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral Sciences, Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.REACH Institute, Department of PsychologyArizona State UniversityTempeUSA
  4. 4.Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, and Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoUSA

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