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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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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).


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.


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.


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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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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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).

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