Summary: Using Cost-Effectiveness Analysis to Prioritize Policy and Programmatic Approaches to Physical Activity Promotion and Obesity Prevention in Childhood

A CHOICES study found that six interventions in school, afterschool, and childcare settings in the U.S. could increase physical activity among children and adolescents and also prevent cases of childhood obesity.

Using Cost-Effectiveness Analysis to Prioritize Policy and Programmatic Approaches to Physical Activity Promotion and Obesity Prevention in Childhood.
Cradock AL, Barrett JL, Kenney EL, Giles CM, Ward ZJ, Long MW, Resch SC, Pipito AA, Wei ER, Gortmaker SL. Prev Med. 2017 Feb;95 Suppl:S17-S27. doi: 10.1016/j.ypmed.2016.10.017
Abstract | Full Text

Though national guidelines from the U.S. Department of Health and Human Services (2008) recommend that both children and adolescents participate in 60 minutes or more of moderate to vigorous physical activity (MVPA) per day, many in this age group throughout the U.S. do not meet this standard. A variety of interventions can increase physical activity among youth, but implementation can be challenging for decision makers who have limited resources and implementation guidance.

The Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) study team identified six physical activity interventions via a systematic review process to project the ten-year population reach, health impact, implementation cost, and health care cost savings of national implementation of each strategy. The six interventions analyzed for cost-effectiveness included:

  • Active Physical Education (Active PE): Focuses on making the time that children spend in PE class more active
  • Active Recess: Focuses on making the time that children spend in school recess periods more active
  • Active School Day: Centers on the integration of strategies to increase physical activity during the school day via Active PE, Active Recess, and movement breaks within the classroom
  • Healthy Afterschool: Focuses on improving physical activity, nutrition, and screen time practices and policies in existing afterschool programs
  • New Afterschool Programs: Centers on creating afterschool programs that include time for physical activity and nutritious snacks for children who otherwise would not attend afterschool programs
  • Hip Hop to Health, Jr.: Focuses on providing structured physical activity in early childcare settings

For all six physical activity-increasing interventions, both cost-effectiveness and obesity impact were modeled. When compared to a base case of no intervention, all six interventions in school, afterschool, and childcare settings are expected to result in significant health care cost savings and reduced cases of childhood obesity in 2025. The main highlights of the study included that:

  • All interventions would increase youth physical activity levels (0.05 to 1.29 MET-hour/day).
  • The cost per MET-hour change/day ranged from cost-saving to $3.14.
  • The interventions could prevent between 2500 and 110,000 cases of children with obesity.

The analysis of these six interventions can provide valuable information to decision-makers on different strategies within structured settings where children spend a lot of time to guide them to the best value for their investment. It can also serve as an impetus for prioritizing the need for improved physical activity interventions and childhood obesity prevention strategies in school, afterschool, and childcare settings.