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Costs and effects of a state-wide health promotion program in primary schools in Germany – the Baden-Württemberg Study: A cluster-randomized, controlled trial

Author

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  • Dorothea Kesztyüs
  • Romy Lauer
  • Tibor Kesztyüs
  • Reinhold Kilian
  • Jürgen M Steinacker
  • on behalf of the “Join the Healthy Boat” Study Group

Abstract

Aim: To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program “Join the Healthy Boat” in primary schools in Germany. Methods: Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated. Results: The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group. Conclusion: This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases. Trial registration: German Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: DRKS00000494.

Suggested Citation

  • Dorothea Kesztyüs & Romy Lauer & Tibor Kesztyüs & Reinhold Kilian & Jürgen M Steinacker & on behalf of the “Join the Healthy Boat” Study Group, 2017. "Costs and effects of a state-wide health promotion program in primary schools in Germany – the Baden-Württemberg Study: A cluster-randomized, controlled trial," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-18, February.
    • Handle: RePEc:plo:pone00:0172332
    DOI: 10.1371/journal.pone.0172332
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    References listed on IDEAS

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    1. Dorothea Kesztyüs & Romy Lauer & Anja Schreiber & Tibor Kesztyüs & Reinhold Kilian & Jürgen Steinacker, 2014. "Parents’ willingness to pay for the prevention of childhood overweight and obesity," Health Economics Review, Springer, vol. 4(1), pages 1-8, December.
    2. Jean-Pierre Després & Isabelle Lemieux, 2006. "Abdominal obesity and metabolic syndrome," Nature, Nature, vol. 444(7121), pages 881-887, December.
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