School of Public Health, University of Alberta, Edmonton, Canada.
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Eur J Public Health. 2021 Dec 1;31(6):1183-1189. doi: 10.1093/eurpub/ckab130.
While school-based health prevention programmes are effective in addressing unhealthy diet and physical inactivity, little is known about their economic implications. We conducted an economic evaluation of the programmes that were previously identified as feasible, acceptable, and sustainable in the Canadian context.
This study builds on a meta-analysis of the effectiveness of feasible, acceptable, and sustainable school-based health promotion programmes. A micro-simulation model incorporated intervention effects on multiple risk factors to estimate incremental cost-effectiveness and return on investment (ROI) of comprehensive school health (CSH), multicomponent, and physical education (PE) curriculum modification programmes. Cost-effectiveness was expressed as the programme costs below which the programme would be cost-effective at a CA$50 000 threshold level.
The estimated costs below which interventions were cost-effective per quality-adjusted life year gained were CA$682, CA$444, and CA$416 per student for CSH, multicomponent, and PE curriculum modification programmes, respectively. CSH programmes remained cost-effective per year of chronic disease prevented for costs of up to CA$3384 per student, compared to CA$1911 and CA$1987 for multicomponent and PE curriculum modification interventions, respectively. If the interventions were implemented at total discounted intervention costs of CA$100 per student, ROI through the avoidance of direct healthcare costs related to the treatment and management of chronic diseases would be 824% for CSH, 465% for multicomponent interventions, and 484% for PE curriculum modification interventions.
Whereas each examined intervention types showed favourable economic benefits, CSH programmes appeared to be the most cost-effective and to have the highest ROI.
虽然基于学校的健康预防计划在解决不健康饮食和缺乏身体活动方面非常有效，但对于其经济意义却知之甚少。我们对在加拿大具有可行性、可接受性和可持续性的计划进行了经济评估。
本研究基于对可行、可接受和可持续的基于学校的健康促进计划的有效性的荟萃分析。微观模拟模型纳入了对多种风险因素的干预效果，以估计综合学校健康（CSH）、多组分和体育教育（PE）课程修改计划的增量成本效益和投资回报率（ROI）。成本效益表示为低于该水平时，计划在 CA$50000 阈值下具有成本效益的方案成本。
每获得一个质量调整生命年的干预成本效益估计值分别为 CA$682、CA$444 和 CA$416，用于 CSH、多组分和 PE 课程修改计划。与多组分和 PE 课程修改干预相比，CSH 计划在学生成本为 CA$3384 或以下时，每预防一年慢性病的成本仍然具有成本效益，而多组分和 PE 课程修改干预的成本分别为 CA$1911 和 CA$1987。如果按照学生每人 100 加元的总折扣干预成本实施干预，那么通过避免与慢性病的治疗和管理相关的直接医疗保健成本，CSH 的投资回报率将达到 824%，多组分干预为 465%，PE 课程修改干预为 484%。
虽然每种干预类型都显示出有利的经济效益，但 CSH 计划似乎是最具成本效益和最高投资回报率的。
