Introduction
Background
Methods
Results
The Cost-Effectiveness of a Community
Component in a School-based Intervention
H. Shelton Brown, III, Nalini Ranjit, Andrew Springer, Steve
Kelder and Deanna Hoelscher
June 27, 2009/ ARM
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Outline
Introduction
Objective
Results
Background
School-based Health Promotion and Cost-Effectiveness
The CATCH Program
Methods
Definitions
Predicting Adulthood Obesity
Results
Costs
CER
Conclusion
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Objective
Introduction
◮
Objective: To assess the net benefit and the
cost-effectiveness of the community component of the
Coordinated Approach to Child Health (CATCH)
intervention program.
◮
During 2007-2008, the CATCH program was introduced
throughout Travis County, Texas schools.
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Objective
Introduction
◮
Objective: To assess the net benefit and the
cost-effectiveness of the community component of the
Coordinated Approach to Child Health (CATCH)
intervention program.
◮
During 2007-2008, the CATCH program was introduced
throughout Travis County, Texas schools.
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Conclusion
Results
Introduction
◮
Results: The results show that community component of
CATCH is cost-effective and net beneficial. The CER was
cost-saving and the NB was US$33,516.21
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Results
Flow Chart
Predict 40−64 year old
Obesity Cases Averted
Include
Intervention
Cost
Include
Medical Costs
Averted
40−64
D
I C
RO
ES
CT
TS
Estimate
Quality−Adjusted
Life Years Saved
(QALYS)
Cost−effectiveness
Ratio
Estimate Labor
Productivity Costs
Averted
40−64
I
N
DC
I O
RS
ET
CS
T
Net Benefits
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Conclusion
School-based Health Promotion and Cost-Effectiveness
Introduction
◮
◮
Wang and Yang demonstrated the CER of Planet Health,
another [Wang et al., 2003]
Brown et al. showed that the CER was US$900
[Brown III et al., 2007]
◮
We will focus on the CER of the community component of
CATCH
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
School-based Health Promotion and Cost-Effectiveness
Introduction
◮
◮
Wang and Yang demonstrated the CER of Planet Health,
another [Wang et al., 2003]
Brown et al. showed that the CER was US$900
[Brown III et al., 2007]
◮
We will focus on the CER of the community component of
CATCH
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
School-based Health Promotion and Cost-Effectiveness
Introduction
◮
◮
Wang and Yang demonstrated the CER of Planet Health,
another [Wang et al., 2003]
Brown et al. showed that the CER was US$900
[Brown III et al., 2007]
◮
We will focus on the CER of the community component of
CATCH
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
The CATCH Program
The CATCH Program
◮ CATCH staff train teachers, PE teachers, cafeteria food
specialists in order to:
◮
◮
◮
Increase physical activity in physical education classes
Improve diets in the cafeteria
Increase health knowledge
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
The CATCH Program
The CATCH Program
◮ CATCH staff train teachers, PE teachers, cafeteria food
specialists in order to:
◮
◮
◮
Increase physical activity in physical education classes
Improve diets in the cafeteria
Increase health knowledge
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
The CATCH Program
The CATCH Program
◮ CATCH staff train teachers, PE teachers, cafeteria food
specialists in order to:
◮
◮
◮
Increase physical activity in physical education classes
Improve diets in the cafeteria
Increase health knowledge
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
The CATCH Program
The CATCH Program
◮ CATCH staff train teachers, PE teachers, cafeteria food
specialists in order to:
◮
◮
◮
Increase physical activity in physical education classes
Improve diets in the cafeteria
Increase health knowledge
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Conclusion
The CATCH Program
The CATCH Community Component
Coordinated School Health CATCH Training
Booster Training Sessions
CATCH Program Materials
CATCH Committee Meetings
Family Fun Night Activities/Events
CATCH Awards Program (recognition and funds for CATCH)
CATCH Component Coordination Kit
Teacher-led Activity Breaks
School Social Marketing Efforts
Supplemental Health Promotion Resourcesb
CATCH Facilitator Support Visits (1 visit/4-6wks.)
Additional CATCH Facilitator Visits (2-3 visits/4-6wks)
CATCH Community "Best Practices" Workshops (3/year)
Community Member required on CATCH Committee
CDC School Health Index used as Planning Tool
School Program and Community Health Promotion Activity Guide
BasicPlus
(15 schools)
X
X
X
X
X
X
X
X
X
X
X
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
BasicPlus+Community
(15 schools)
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Introduction
Background
Methods
Results
Conclusion
Definitions
NB versus CER
◮ Net-Benefit (NB)
◮
◮
Decision Rule: Undertake an intervention if the value of the
averted medical and labor costs exceed the intervention
cost
Cost-Effectiveness Ratio (CER)
◮
Decision Rule: Undertake an intervention if the cost per
quality-adjusted life-year added is less than $50,000
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
NB versus CER
◮ Net-Benefit (NB)
◮
◮
Decision Rule: Undertake an intervention if the value of the
averted medical and labor costs exceed the intervention
cost
Cost-Effectiveness Ratio (CER)
◮
Decision Rule: Undertake an intervention if the cost per
quality-adjusted life-year added is less than $50,000
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
NB versus CER
◮ Net-Benefit (NB)
◮
◮
Decision Rule: Undertake an intervention if the value of the
averted medical and labor costs exceed the intervention
cost
Cost-Effectiveness Ratio (CER)
◮
Decision Rule: Undertake an intervention if the cost per
quality-adjusted life-year added is less than $50,000
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
NB versus CER
◮ Net-Benefit (NB)
◮
◮
Decision Rule: Undertake an intervention if the value of the
averted medical and labor costs exceed the intervention
cost
Cost-Effectiveness Ratio (CER)
◮
Decision Rule: Undertake an intervention if the cost per
quality-adjusted life-year added is less than $50,000
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
Cost-Effectiveness
CER = (C −
X
i
◮
Ni × Ai )/
X
N i × Qi
i
i = m, f indicates male and female, respectively
C represents the costs of the CATCH intervention in 2004
dollars
Ni represents the number of adult obese cases averted
due to CATCH
Ai represents the averted medical costs when obese
adults aged 40-64 are instead non-obese adults
Qi represents the additional QALY s gained when obese
adults are instead non-obese.
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
Net Benefits
NB =
X
i
◮
Ni × Ai +
X
Ni × Bi − C
i
i = m, f indicates male and female, respectively Bi
represents the value of productivity gains for someone who
is non-obese rather than obese.
◮
Note that we are not trying to monetize the utility of avoiding
obesity (stigma, low self-esteem, etc.)
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
Net Benefits
NB =
X
i
◮
Ni × Ai +
X
Ni × Bi − C
i
i = m, f indicates male and female, respectively Bi
represents the value of productivity gains for someone who
is non-obese rather than obese.
◮
Note that we are not trying to monetize the utility of avoiding
obesity (stigma, low self-esteem, etc.)
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
QALYs
◮ We estimated the QALY scales (weights for quality of
years) using NHIS (2002) data
◮
Placed each individual in the Activity Scales Matrix above
◮
◮
◮
NHIS allows the identification of obese adults
Life-expectancy and death probabilities from a Life Table for
obese adults based on the Framingham
Study.[Peeters et al., 2003]
Note: Only looked at increased life-expectancy until 65
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
QALYs
◮ We estimated the QALY scales (weights for quality of
years) using NHIS (2002) data
◮
Placed each individual in the Activity Scales Matrix above
◮
◮
◮
NHIS allows the identification of obese adults
Life-expectancy and death probabilities from a Life Table for
obese adults based on the Framingham
Study.[Peeters et al., 2003]
Note: Only looked at increased life-expectancy until 65
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
QALYs
◮ We estimated the QALY scales (weights for quality of
years) using NHIS (2002) data
◮
Placed each individual in the Activity Scales Matrix above
◮
◮
◮
NHIS allows the identification of obese adults
Life-expectancy and death probabilities from a Life Table for
obese adults based on the Framingham
Study.[Peeters et al., 2003]
Note: Only looked at increased life-expectancy until 65
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
QALYs
◮ We estimated the QALY scales (weights for quality of
years) using NHIS (2002) data
◮
Placed each individual in the Activity Scales Matrix above
◮
◮
◮
NHIS allows the identification of obese adults
Life-expectancy and death probabilities from a Life Table for
obese adults based on the Framingham
Study.[Peeters et al., 2003]
Note: Only looked at increased life-expectancy until 65
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Definitions
QALYs
◮ We estimated the QALY scales (weights for quality of
years) using NHIS (2002) data
◮
Placed each individual in the Activity Scales Matrix above
◮
◮
◮
NHIS allows the identification of obese adults
Life-expectancy and death probabilities from a Life Table for
obese adults based on the Framingham
Study.[Peeters et al., 2003]
Note: Only looked at increased life-expectancy until 65
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Definitions
QALY Activity Scale Definitions
Activity Limitation
Excellent
Not Limited
1.00
Limited-other
0.87
Limited-major
0.81
Unable-major
0.68
Limited in IADL*
0.57
Limited in ADL**
0.47
*IADL (shopping, cooking. etc.)
**ADL (Bathing, dressing, etc.)
Source: [Erickson et al., 1995]
Self-Assessed Health
Very Good
Good
0.92
0.84
0.79
0.72
0.74
0.67
0.62
0.55
0.51
0.45
0.41
0.36
Fair
0.63
0.52
0.48
0.38
0.29
0.21
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Poor
0.47
0.38
0.34
0.25
0.17
0.10
Conclusion
Introduction
Background
Methods
Results
Definitions
Discounting NB and CER
◮
◮
We take a societal view of costs
We discount all future averted costs at a 3% rate
◮
We allow this rate of discount to vary in our sensitivity
analysis
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Definitions
Discounting NB and CER
◮
◮
We take a societal view of costs
We discount all future averted costs at a 3% rate
◮
We allow this rate of discount to vary in our sensitivity
analysis
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Definitions
Discounting NB and CER
◮
◮
We take a societal view of costs
We discount all future averted costs at a 3% rate
◮
We allow this rate of discount to vary in our sensitivity
analysis
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
El Paso Trial
At−Risk Averted
El Paso Trial
Overweight Averted
Age 11
Obesity Averted
Age 20−29
Obesity Averted
Age 40
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮ Overweight and at-risk children are not expensive in the
near-term, but they become so later on
◮
◮
◮
Used parameters from the CATCH trial for averted at-risk
(85-95 percentile for sex and age) and overweight (>95
percentile for sex and age)
Used parameters from Whitaker et al.[Whitaker et al., 1997]
for the probability of obesity during ages 21-29 conditional
on at-risk or overweight a 11.
In order to estimate the probability of obesity at age 40
conditional on being obese during ages 21-29, we linked
1992, 1987, and 1982 NHANES I Epidemiologic Followup
Study (NHEFS) data with the original 1975 National Health
and Nutrition Examination Survey (NHANES) I
data.[Cohen et al., 1987]
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮ Overweight and at-risk children are not expensive in the
near-term, but they become so later on
◮
◮
◮
Used parameters from the CATCH trial for averted at-risk
(85-95 percentile for sex and age) and overweight (>95
percentile for sex and age)
Used parameters from Whitaker et al.[Whitaker et al., 1997]
for the probability of obesity during ages 21-29 conditional
on at-risk or overweight a 11.
In order to estimate the probability of obesity at age 40
conditional on being obese during ages 21-29, we linked
1992, 1987, and 1982 NHANES I Epidemiologic Followup
Study (NHEFS) data with the original 1975 National Health
and Nutrition Examination Survey (NHANES) I
data.[Cohen et al., 1987]
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮ Overweight and at-risk children are not expensive in the
near-term, but they become so later on
◮
◮
◮
Used parameters from the CATCH trial for averted at-risk
(85-95 percentile for sex and age) and overweight (>95
percentile for sex and age)
Used parameters from Whitaker et al.[Whitaker et al., 1997]
for the probability of obesity during ages 21-29 conditional
on at-risk or overweight a 11.
In order to estimate the probability of obesity at age 40
conditional on being obese during ages 21-29, we linked
1992, 1987, and 1982 NHANES I Epidemiologic Followup
Study (NHEFS) data with the original 1975 National Health
and Nutrition Examination Survey (NHANES) I
data.[Cohen et al., 1987]
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮ Overweight and at-risk children are not expensive in the
near-term, but they become so later on
◮
◮
◮
Used parameters from the CATCH trial for averted at-risk
(85-95 percentile for sex and age) and overweight (>95
percentile for sex and age)
Used parameters from Whitaker et al.[Whitaker et al., 1997]
for the probability of obesity during ages 21-29 conditional
on at-risk or overweight a 11.
In order to estimate the probability of obesity at age 40
conditional on being obese during ages 21-29, we linked
1992, 1987, and 1982 NHANES I Epidemiologic Followup
Study (NHEFS) data with the original 1975 National Health
and Nutrition Examination Survey (NHANES) I
data.[Cohen et al., 1987]
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
Ni = Hi × (P5i − P6i ) ×
X
((P2ij8 − P2ij7 ) − (P1ij8 − P1ij7 )) × (P3ij − P4ij ),
j
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
(1)
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮
subscript i = m, f indicates male and female and j = a, o
represent at-risk or overweight
◮
Ni represents the number of adult obese cases averted
due to CATCH
◮
Hi represents the number of children in the trial
◮
P5i is the probability of obesity at age 40 conditional on
being obese at age 21 to 29; P6i is the probability of
obesity at age 40 conditional on not being obese at age 21
to 29
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮
subscript i = m, f indicates male and female and j = a, o
represent at-risk or overweight
◮
Ni represents the number of adult obese cases averted
due to CATCH
◮
Hi represents the number of children in the trial
◮
P5i is the probability of obesity at age 40 conditional on
being obese at age 21 to 29; P6i is the probability of
obesity at age 40 conditional on not being obese at age 21
to 29
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮
subscript i = m, f indicates male and female and j = a, o
represent at-risk or overweight
◮
Ni represents the number of adult obese cases averted
due to CATCH
◮
Hi represents the number of children in the trial
◮
P5i is the probability of obesity at age 40 conditional on
being obese at age 21 to 29; P6i is the probability of
obesity at age 40 conditional on not being obese at age 21
to 29
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮
subscript i = m, f indicates male and female and j = a, o
represent at-risk or overweight
◮
Ni represents the number of adult obese cases averted
due to CATCH
◮
Hi represents the number of children in the trial
◮
P5i is the probability of obesity at age 40 conditional on
being obese at age 21 to 29; P6i is the probability of
obesity at age 40 conditional on not being obese at age 21
to 29
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮
P3ij captures the probabilities of obesity at age 21 to 29
conditional on being at-risk and conditional on being obese
at age 11; P4ij measures the probabilities of obesity at age
21 to 29 conditional on being not at-risk and conditional on
being not obese at age 11
◮
P2ij8 and P2ij7 are the proportions of at-risk and overweight
children in grade 4 in ’07 and ’08; P1ij8 and P1ij7 are the
proportions of at-risk and overweight children in grade 4 in
’07 and ’08 in the BPC schools
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Predicting Adulthood Obesity
◮
P3ij captures the probabilities of obesity at age 21 to 29
conditional on being at-risk and conditional on being obese
at age 11; P4ij measures the probabilities of obesity at age
21 to 29 conditional on being not at-risk and conditional on
being not obese at age 11
◮
P2ij8 and P2ij7 are the proportions of at-risk and overweight
children in grade 4 in ’07 and ’08; P1ij8 and P1ij7 are the
proportions of at-risk and overweight children in grade 4 in
’07 and ’08 in the BPC schools
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Labor Productivity and Obesity
◮ Missed sick days and years of productivity lost until turn 65
◮
Used NHIS (2002) data to estimate extra sick days for
obese adults
◮
◮
Poisson regression controlling for controlled for age, age
40-64, smoking status, Hispanic ethnicity, and gender
Wage data came from the US Department of Labor wage
data[U.S. Department of Labor, 2004]
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Labor Productivity and Obesity
◮ Missed sick days and years of productivity lost until turn 65
◮
Used NHIS (2002) data to estimate extra sick days for
obese adults
◮
◮
Poisson regression controlling for controlled for age, age
40-64, smoking status, Hispanic ethnicity, and gender
Wage data came from the US Department of Labor wage
data[U.S. Department of Labor, 2004]
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Labor Productivity and Obesity
◮ Missed sick days and years of productivity lost until turn 65
◮
Used NHIS (2002) data to estimate extra sick days for
obese adults
◮
◮
Poisson regression controlling for controlled for age, age
40-64, smoking status, Hispanic ethnicity, and gender
Wage data came from the US Department of Labor wage
data[U.S. Department of Labor, 2004]
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Predicting Adulthood Obesity
Labor Productivity and Obesity
◮ Missed sick days and years of productivity lost until turn 65
◮
Used NHIS (2002) data to estimate extra sick days for
obese adults
◮
◮
Poisson regression controlling for controlled for age, age
40-64, smoking status, Hispanic ethnicity, and gender
Wage data came from the US Department of Labor wage
data[U.S. Department of Labor, 2004]
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Characteristics of 4th grade students by type of intervention
N of students (Spring 2007)
Age in years (mean, SD)
Gender (n,%)
Female
Male
Ethnicity (n,%)
African American
Hispanic
White other
Percent economically disadvantaged (mean, SD)
Students attending largest school district (n, %)
N of students (Spring 2008)
BasicPlus (BP)
(n = 15 schools)
554
10.0 (0.71)
BasicPlus + Community (BPC)
(n = 15 schools)
553
9.85 (0.38)
299 (54%)
255 (46%)
284 (51%)
268 (49%)
85 (15%)
339 (61%)
130 (23%)
90.0 (6.7)
458 (83%)
699
76 (14%)
382 (69%)
95 (17%)
88.6 (8.12)
421 (76%)
471
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Conclusion
Introduction
Background
Methods
Results
Conclusion
Results of CATCH trial by type of intervention
BasicPlus Schools
’07
’08
△
p − val
Percent ≥ 85 percentile
Total
42
40.7
−1.3
(p=0.33)
Gender
Boys
45.3
43.4
−1.9
(p=0.33)
39.3
38
−1.3
(p=0.37)
Girls
Ethnicity
White
30.7
28.6
−2.1
(p=0.42)
AA
41.5
39.8
−1.7
(p=0.40)
51.6
50.1
−1.5
(p=0.34)
Hispanic
Percent ≥ 95th percentile
Total
23.9
22
−1.9
(p=0.21)
Gender
Boys
29
25.4
−3.6
(p=0.16)
19.7
19.3
−0.4
(p=0.44)
Girls
Ethnicity
White
8.5
10.1
1.6
(p=0.39)
22.5
24.8
2.3
(p=0.36)
AA
Hispanic
31.7
29.4
−2.3
(p=0.25)
’07
BasicPlus+ Comm Schools
’08
△
p − val
BPC-BP
p − val
th
47.4
39.1
−8.3
(p=0.005)
−7.0
(p=0.051)
51
44
43.2
35
−7.8
−9.0
(p=0.047)
(p=0.020)
−5.9
−7.7
(p=0.18)
(p=0.09)
31.7
47.7
50.8
17.1
50.8
43.3
−14.6
3.1
−7.5
(p=0.12)
(p=0.38)
(p=0.26)
−12.5
4.8
−6.0
(p=0.20)
(p=0.35)
(p=0.14)
27.5
23.9
−3.6
(p=0.09)
−1.7
(p=0.33)
32.7
23.2
30.1
18.4
−2.6
−4.8
(p=0.27)
(p=0.09)
1
−4.4
(p=0.41)
(p=0.18)
13.6
32
28.9
11.5
37.2
27.5
−2.1
5.2
−1.4
(p=0.41)
(p=0.29)
(p=0.34)
−3.7
2.9
0.9
(p=0.36)
(p=0.42)
(p=0.44)
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Costs
CATCH BPC Costs
Additional CATCH Facilitator Visits
CATCH Community Best
practice Workshops
Community Member Required on CATCH Committee
Community Activity Devised by School*
# Schools
# CATCH
# School
# meetings/yr
15
1
1
18
# hours/meeting
1
12521.64
15
5
3
3
2
17012.99
15
0
1
18
1.5
5922.35
Cost
CDC School Index Used as
Planning Tool
School Program and Community Health Promotion
Guide
*Omitted for now
Total Cost
15
5
75
15
5
75
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
35606.97
Introduction
Background
Methods
Results
Conclusion
CER
Results and Sensitivity Analysis (48 Parameters)
Variable
Cases overweight prevented (N)
Medical Costs Averted (N X A)
QALYs Saved (N X Q)
Costs of lost labor productivity averted (N X B)
Cost-effectiveness ratio (C-NA)/NQ
Net Benefit (C-NA-NB)
Mean
17.09
41189.48
8.38
Lower Limit
16.8
40480.39
8.23
Upper Lim
17.38
41898.56
8.53
30052.58
28257.31
31847.85
-228.15
35635.05
-344.74
33516.21
-111.55
37753.90
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Conclusion
◮
CATCH is cost-effective and net beneficial. The CER is
cost saving and the NB is US$33,516.21
◮
Community component is cost-effective and net beneficial
◮
The sensitivity analysis reveals that the results are robust
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Conclusion
◮
CATCH is cost-effective and net beneficial. The CER is
cost saving and the NB is US$33,516.21
◮
Community component is cost-effective and net beneficial
◮
The sensitivity analysis reveals that the results are robust
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Conclusion
◮
CATCH is cost-effective and net beneficial. The CER is
cost saving and the NB is US$33,516.21
◮
Community component is cost-effective and net beneficial
◮
The sensitivity analysis reveals that the results are robust
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Brown III, H. S., Peréz, A., Li, Y.-P., Hoelsher, D., Kelder, S.,
& Rivera, R. (2007).
The cost-effectiveness of a school-based overweight
program.
International Journal of Behavioral Nutrition and Physical
Activity, 4(47).
Cohen, B. B., Barbano, H. E., Cox, C. S., Feldman, J. J.,
Finucane, F. F., Kleinman, J. C., & Madans, J. H. (1987).
Plan and operation of the NHANES I epidemiologic
followup study: 1982-84.
Vital and Health Statistics. Ser. 1: Programs and Collection
Procedures, (22)(22), 1–142.
Erickson, P., Wilson, R., & Shannon, I. (1995).
Years of healthy life.
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Healthy People 2000 Statistical Notes / National Center for
Health Statistics, (7)(7), 1–15.
Peeters, A., Barendregt, J. J., Willekens, F., Mackenbach,
J. P., Mamun, A. A., Bonneux, L., NEDCOM, t. N. E., &
of Morbidity Research Group., D. C. (2003).
Obesity in adulthood and its consequences for life
expectancy: a life-table analysis.
Annals of Internal Medicine, 138(1), 24–32.
U.S. Department of Labor (2004).
Highlights of Women’s Earnings in 2003.
Technical report, Bureau of Labor Statistics.
Wang, L. Y., Yang, Q., Lowry, R., & Wechsler, H. (2003).
Economic analysis of a school-based obesity prevention
program.
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living
Introduction
Background
Methods
Results
Conclusion
Obesity Research, 11(11), 1313–1324.
Whitaker, R. C., Wright, J. A., Pepe, M. S., Seidel, K. D., &
Dietz, W. H. (1997).
Predicting obesity in young adulthood from childhood and
parental obesity.
The New England Journal of Medicine, 337(13), 869–873.
The Cost-Effectiveness of a Community Component in a School-based Intervention
University of Texas School of Public Health Dell Center for the Advancement of Healthy Living