Deakin University, Deakin Health Economics, Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation (IHT), Geelong, Australia.
Deakin University, Deakin Health Economics, Institute for Health Transformation, Geelong, Australia.
Int J Behav Nutr Phys Act. 2024 Feb 12;21(1):15. doi: 10.1186/s12966-024-01560-3.
Improving physical activity and reducing sedentary behavior represent important areas for intervention in childhood in order to reduce the burden of chronic disease related to obesity and physical inactivity in later life. This paper aims to determine the cost-effectiveness of a multi-arm primary school-based intervention to increase physical activity and/or reduce sedentary time in 8-9 year old children (Transform-Us!).
Modelled cost-utility analysis, using costs and effects from a cluster randomized controlled trial of a 30-month intervention that used pedagogical and environmental strategies to reduce and break up sedentary behaviour (SB-I), promote physical activity (PA-I), or a combined approach (PA + SB-I), compared to current practice. A validated multiple-cohort lifetable model (ACE-Obesity Policy model) estimated the obesity and physical activity-related health outcomes (measured as change in body mass index and change in metabolic equivalent task minutes respectively) and healthcare cost-savings over the cohort's lifetime from the public-payer perspective, assuming the intervention was delivered to all 8-9 year old children attending Australian Government primary schools. Sensitivity analyses tested the impact on cost-effectiveness of varying key input parameters, including maintenance of intervention effect assumptions.
Cost-effectiveness results demonstrated that, when compared to control schools, the PA-I and SB-I intervention arms were "dominant", meaning that they resulted in net health benefits and healthcare cost-savings if the intervention effects were maintained. When the costs and effects of these intervention arms were extrapolated to the Australian population, results suggested significant potential as obesity prevention measures (PA-I: 60,780 HALYs saved (95% UI 15,007-109,413), healthcare cost-savings AUD641M (95% UI AUD165M-$1.1B); SB-I: 61,126 HALYs saved (95% UI 11,770 - 111,249), healthcare cost-savings AUD654M (95% UI AUD126M-1.2B)). The PA-I and SB-I interventions remained cost-effective in sensitivity analysis, assuming the full decay of intervention effect after 10 years.
The PA-I and SB-I Transform-Us! intervention arms represent good value for money and could lead to health benefits and healthcare cost-savings arising from the prevention of chronic disease in later life if intervention effects are sustained.
International Standard Randomized Controlled Trial Number (ISRCTN83725066). Australia and New Zealand Clinical Trials Registry Number (ACTRN12609000715279).
在儿童时期，提高身体活动水平和减少久坐行为是干预的重要领域，目的是降低与肥胖和身体不活动相关的慢性病负担。本文旨在确定一项多臂小学为基础的干预措施的成本效益，该措施旨在增加 8-9 岁儿童的身体活动量和/或减少久坐时间（Transform-Us！）。
采用成本效用分析模型，对一项为期 30 个月的干预措施进行了建模，该干预措施使用教学和环境策略来减少和打破久坐行为（SB-I）、促进身体活动（PA-I）或采取综合方法（PA+SB-I），与现行做法进行比较。一个经过验证的多队列生命表模型（ACE-Obesity Policy 模型）从公共支付者的角度估计了肥胖和与身体活动相关的健康结果（分别衡量为体重指数的变化和代谢当量任务分钟数的变化）和医疗保健成本节约，假设该干预措施被提供给所有参加澳大利亚政府小学的 8-9 岁儿童。敏感性分析测试了改变关键输入参数对成本效益的影响，包括维持干预效果的假设。
成本效益结果表明，与对照学校相比，PA-I 和 SB-I 干预组具有“优势”，这意味着如果维持干预效果，它们将带来净健康效益和医疗保健成本节约。当这些干预组的成本和效果推广到澳大利亚人群时，结果表明它们具有作为肥胖预防措施的巨大潜力（PA-I：节省 60780 个健康调整生命年（95%UI 15007-109413），节省医疗保健成本 6.41 亿澳元（95%UI 1.65 亿澳元-11 亿澳元）；SB-I：节省 61126 个健康调整生命年（95%UI 11770-111249），节省医疗保健成本 6.54 亿澳元（95%UI 1260 万澳元-12 亿澳元））。在敏感性分析中，假设干预效果在 10 年后完全衰减，PA-I 和 SB-I 干预仍然具有成本效益。
如果干预效果得以维持，PA-I 和 SB-I 的 Transform-Us！干预措施具有良好的性价比，并可能通过预防晚年慢性疾病带来健康效益和医疗保健成本节约。
国际标准随机对照试验编号（ISRCTN83725066）。澳大利亚和新西兰临床试验注册处编号（ACTRN12609000715279）。
