title: The cost-effectiveness of Australia's Active After-School Communities program.
abstract: The objective of this study was to assess from a societal perspective the cost-effectiveness of the Active After-school Communities (AASC) program, a key plank of the former Australian Government's obesity prevention program. The intervention was modeled for a 1-year time horizon for Australian primary school children as part of the Assessing Cost-Effectiveness in Obesity (ACE-Obesity) project. Disability-adjusted life year (DALY) benefits (based on calculated effects on BMI post-intervention) and cost-offsets (consequent savings from reductions in obesity-related diseases) were tracked until the cohort reached the age of 100 years or death. The reference year was 2001, and a 3% discount rate was applied. Simulation-modeling techniques were used to present a 95% uncertainty interval around the cost-effectiveness ratio. An assessment of second-stage filter criteria ("equity," "strength of evidence," "acceptability to stakeholders," "feasibility of implementation," "sustainability," and "side-effects") was undertaken by a stakeholder Working Group to incorporate additional factors that impact on resource allocation decisions. The estimated number of children new to physical activity after-school and therefore receiving the intervention benefit was 69,300. For 1 year, the intervention cost is Australian dollars (AUD) 40.3 million (95% uncertainty interval AUD 28.6 million; AUD 56.2 million), and resulted in an incremental saving of 450 (250; 770) DALYs. The resultant cost-offsets were AUD 3.7 million, producing a net cost per DALY saved of AUD 82,000 (95% uncertainty interval AUD 40,000; AUD 165,000). Although the program has intuitive appeal, it was not cost-effective under base-case modeling assumptions. To improve its cost-effectiveness credentials as an obesity prevention measure, a reduction in costs needs to be coupled with increases in the number of participating children and the amount of physical activity undertaken.
authors.affiliation: Deakin Health Economics, Public Health Research Evaluation and Policy Cluster, Deakin University, Burwood, Victoria, Australia. marj.moodie@deakin.edu.au
authors.forename: Marjory L
authors.initials: ML
authors.lastname: Moodie
authors.forename: Robert C
authors.initials: RC
authors.lastname: Carter
authors.forename: Boyd A
authors.initials: BA
authors.lastname: Swinburn
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Haby
mesh_terms: D001315:Australia; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D003153:Community Health Services / Q000191:economics*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D015444:Exercise; D006801:Humans; D009765:Obesity / Q000191:economics / Q000517:prevention & control*; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation; D012574:Schools