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Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

ABSTRACT: BACKGROUND:The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a "best practice" in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project's cost-effectiveness following a life-course approach. METHODS:We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system's cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. RESULTS:The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICER

SUBMITTER: Ekwaru JP

PROVIDER: S-EPMC5436822 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

Ekwaru John Paul JP Ohinmaa Arto A Tran Bach Xuan BX Setayeshgar Solmaz S Johnson Jeffrey A JA Veugelers Paul J PJ

PloS one 20170518 5

<h4>Background</h4>The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a "best practice" in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project's cost-effectiveness following a life-course approach.<h4>Methods</h4>We developed a state transition model for the lifetime progression of body weight status comparing elementary school studen ...[more]

PMID: 28542399

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Project description:BackgroundThere is growing research support for the use of mindfulness training (MT) in schools, but almost no high-quality evidence about different training models for people wishing to teach mindfulness in this setting. Effective dissemination of MT relies on the development of scalable training routes.ObjectiveTo compare 4 training routes for school teachers wishing to deliver MT differing in intensity and potential scalability, considering teaching competency, training acceptability, and cost-effectiveness.MethodsSchools were randomized to an existing route comprising an 8-session instructor-led personal mindfulness course, combined with 4-day MT program training, or 1 of 3 more scalable, lower intensity, alternatives: an instructor-led personal mindfulness course combined with 1-day MT program training, a self-taught personal mindfulness course (delivered through a course book) combined with 4-day MT program training, and a self-taught personal mindfulness course combined with 1-day MT program training.ResultsAttrition from training was substantial across all routes. The instructor-led course was more effective than the self-taught course in increasing teachers' personal mindfulness skills. Even the most intensive (existing) training route brought only 29% of the teachers commencing training, and 56% of those completing the study protocol, to the required minimum competency threshold (an advanced beginner rating on an adapted version of the Mindfulness-based Interventions Teaching Assessment Criteria). The differences in levels of competency achieved by existing training compared with the more scalable alternatives were modest, with economic evaluation suggesting that the existing route was both more expensive and more effective than lower intensity alternatives, but with no statistically significant differences between routes.ConclusionsThis research questions the move toward abbreviating teacher training to increase scalability and suggests instead that many teachers require additional support to ensure competency from first delivery of MT in the classroom.

Dataset Information

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

Publications

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

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