title: Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S.
abstract: BACKGROUND
  Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities.
  
  
  METHODS
  Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention's impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3% annually. Probabilistic sensitivity analyses simulated 95% uncertainty intervals (UIs) around outcomes.
  
  
  RESULTS
  Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95% UI=$14.2, $134) million. The intervention is 94.7% likely to be cost saving by 2025.
  
  
  CONCLUSIONS
  Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington. Electronic address: davene.wright@seattlechildrens.org.
authors.forename: Davene R
authors.initials: DR
authors.lastname: Wright
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Kenney
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Giles
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Long
authors.affiliation: Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Ward
authors.affiliation: Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Resch
authors.affiliation: Deakin Health Economics, Deakin Population Health, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Marj L
authors.initials: ML
authors.lastname: Moodie
authors.affiliation: Deakin Health Economics, Deakin Population Health, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Carter
authors.affiliation: Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, New York.
authors.forename: Y Claire
authors.initials: YC
authors.lastname: Wang
authors.affiliation: WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Sacks
authors.affiliation: WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Boyd A
authors.initials: BA
authors.lastname: Swinburn
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Angie L
authors.initials: AL
authors.lastname: Cradock
mesh_terms: D002654:Child Care / Q000191:economics*; D000067576:Child Health / Q000331:legislation & jurisprudence*; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005102:Health Expenditures; D006291:Health Policy / Q000639:trends*; D006801:Humans; D018803:Models, Economic; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States