Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, United States of America.
Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, United States of America.
PLoS One. 2022 May 6;17(5):e0268118. doi: 10.1371/journal.pone.0268118. eCollection 2022.
Many schools have been cutting physical education (PE) classes due to budget constraints, which raises the question of whether policymakers should require schools to offer PE classes. Evidence suggests that PE classes can help address rising physical inactivity and obesity prevalence. However, it would be helpful to determine if requiring PE is cost-effective.
We developed an agent-based model of youth in Mexico City and the impact of all schools offering PE classes on changes in weight, weight-associated health conditions and the corresponding direct and indirect costs over their lifetime.
If schools offer PE without meeting guidelines and instead followed currently observed class length and time active during class, overweight and obesity prevalence decreased by 1.3% (95% CI: 1.0%-1.6%) and was cost-effective from the third-party payer and societal perspectives ($5,058 per disability-adjusted life year [DALY] averted and $5,786/DALY averted, respectively, assuming PE cost $50.3 million). When all schools offered PE classes meeting international guidelines for PE classes, overweight and obesity prevalence decreased by 3.9% (95% CI: 3.7%-4.3%) in the cohort at the end of five years compared to no PE. Long-term, this averted 3,183 and 1,081 obesity-related health conditions and deaths, respectively and averted ≥$31.5 million in direct medical costs and ≥$39.7 million in societal costs, assuming PE classes cost ≤$50.3 million over the five-year period. PE classes could cost up to $185.5 million and $89.9 million over the course of five years and still remain cost-effective and cost saving respectively, from the societal perspective.
Requiring PE in all schools could be cost-effective when PE class costs, on average, up to $10,340 per school annually. Further, the amount of time students are active during class is a driver of PE classes' value (e.g., it is cost saving when PE classes meet international guidelines) suggesting the need for specific recommendations.
由于预算限制，许多学校已经削减了体育课（PE），这就提出了一个问题，即决策者是否应该要求学校提供体育课。有证据表明，体育课有助于解决日益严重的身体活动不足和肥胖流行问题。然而，确定要求体育课是否具有成本效益是很有帮助的。
我们建立了一个基于墨西哥城青少年和所有学校提供体育课对体重变化、与体重相关的健康状况以及他们一生的直接和间接成本影响的代理模型。
如果学校提供体育课，但不符合指导方针，而是遵循目前观察到的课程长度和课堂活动时间，超重和肥胖的患病率将分别降低 1.3%（95%置信区间：1.0%-1.6%），从第三方支付者和社会角度来看，这是具有成本效益的（每避免一个残疾调整生命年（DALY）分别为 5058 美元和 5786 美元，假设体育课成本为 5030 万美元）。当所有学校都按照国际体育课指南开设体育课时，与没有体育课相比，五年后队列中超重和肥胖的患病率将降低 3.9%（95%置信区间：3.7%-4.3%）。从长期来看，这分别避免了 3183 例和 1081 例肥胖相关的健康状况和死亡，并避免了 3150 万美元以上的直接医疗费用和 3970 万美元以上的社会成本，假设体育课在五年内的成本不超过 5030 万美元。从社会角度来看，体育课的成本最高可达 1855 万美元和 8990 万美元，在五年内仍具有成本效益和节省成本。
当体育课的平均成本达到每年每所学校 10340 美元时，要求所有学校都上体育课可能具有成本效益。此外，学生在课堂上的活动时间是体育课价值的驱动因素（例如，当体育课符合国际指南时，它可以节省成本），这表明需要有具体的建议。
