Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing, China.
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
BMC Public Health. 2020 Oct 23;20(1):1608. doi: 10.1186/s12889-020-09718-x.
Economic evaluation of school-based obesity interventions could provide support for public health decision of obesity prevention. This study is to perform cost-utility and cost-benefit assessment of three school-based childhood obesity interventions including nutrition education intervention (NE), physical activity intervention (PA) and comprehensive intervention (both NE and PA, CNP) with secondary data analysis of one randomized controlled trial.
The standard cost-effectiveness analysis methods were employed from a societal perspective to the health outcome and costs that are attributable to the intervention. NE, PA and CNP were carried out separately for 2 semesters for childhood obesity interventions in primary schools. The additional quality-adjusted life years (QALYs) resulting from the interventions were measured as the health outcome. A cost-utility ratio (CUR) and A cost-benefit ratio (CBR) was calculated as the ratio of implementation costs to the total medical and productivity loss costs averted by the interventions.
The CUR and CBR were ¥11,505.9 ($1646.0) per QALY and ¥1.2 benefit per ¥1 cost respectively, and the net saving was ¥73,659.6 ($10,537.9). The CUR and CBR for nutrition education and physical activity interventions were ¥21,316.4 ($3049.6) per QALY and ¥0.7 benefit per ¥1 cost, ¥28,417.1 ($4065.4) per QALY and ¥0.4 benefit per ¥1 cost, respectively (in 2019 RMB). Compared with PA intervention, the ICERs were ¥10,335.2 ($1478.6) and 4626.3 ($661.8) for CNP and NE respectively. The CBR was ¥1.2, 0.7, and 0.4 benefits per ¥1 cost for CNP, NE, and PA interventions, respectively. Net estimated savings were achieved only through CNP intervention, amounting to ¥73,659.6 ($10,537.9).
Comprehensive school-based obesity intervention is a beneficial investment that is both cost-effective and cost saving. Compared with PA intervention, both CNP and NE intervention were more cost-effective.
基于经济学的视角评价学校肥胖干预措施的效果，可为公共卫生决策提供科学依据。本研究旨在通过对一项随机对照试验的二次数据分析，对三种基于学校的儿童肥胖干预措施（营养教育干预、身体活动干预和综合干预）进行成本-效用和成本效益分析。
从社会角度出发，采用标准成本效益分析方法，以干预措施产生的健康结果和成本为依据。在小学开展为期两个学期的儿童肥胖干预，分别实施营养教育、身体活动和综合干预。干预措施带来的额外质量调整生命年（QALY）作为健康结果进行测量。实施成本与干预措施避免的医疗和生产力损失总成本之比为成本效用比（CUR），成本效益比（CBR）为干预措施获得的收益与实施成本之比。
营养教育和身体活动干预的 CUR 和 CBR 分别为每 QALY 11505.9 元（1646.0 美元）和每 1 元成本可获得 0.7 个效益，净节省 73659.6 元（10537.9 美元）。综合干预的 CUR 和 CBR 分别为每 QALY 12316.4 元（1746.0 美元）和每 1 元成本可获得 0.4 个效益，每 QALY 28417.1 元（4065.4 美元）和每 1 元成本可获得 0.4 个效益（均以 2019 年人民币计价）。与身体活动干预相比，综合干预和营养教育干预的增量成本效益比（ICER）分别为 10335.2 元和 4626.3 元。综合干预、营养教育干预和身体活动干预的 CBR 分别为每 1 元成本可获得 1.2、0.7 和 0.4 个效益。仅综合干预实现了净估计节省，为 73659.6 元（10537.9 美元）。
综合学校肥胖干预是一种有益的投资，具有成本效益和成本节约的双重效果。与身体活动干预相比，综合干预和营养教育干预更具成本效益。
