title: Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES.
abstract: BACKGROUND
  The childhood obesity epidemic continues in the U.S., and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However, cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE).
  
  
  METHODS
  Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness, implementation, and equity issues were reviewed.
  
  
  RESULTS
  Population reach varied widely, and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At 10 years, assuming maintenance of the intervention effect, three interventions would save net costs, with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years, and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue.
  
  
  CONCLUSIONS
  The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Electronic address: sgortmak@hsph.harvard.edu.
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: Michael W
authors.initials: MW
authors.lastname: Long
authors.affiliation: Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Resch
authors.affiliation: Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Ward
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
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Barrett
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Davene R
authors.initials: DR
authors.lastname: Wright
authors.affiliation: Division of Adolescent Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Kendrin R
authors.initials: KR
authors.lastname: Sonneville
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: Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Rob C
authors.initials: RC
authors.lastname: Carter
authors.affiliation: Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Marj L
authors.initials: ML
authors.lastname: Moodie
authors.affiliation: Deakin Health Economics, Faculty of Health, 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; School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Boyd A
authors.initials: BA
authors.lastname: Swinburn
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Amber
authors.initials: A
authors.lastname: Hsiao
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Seanna
authors.initials: S
authors.lastname: Vine
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jan
authors.initials: J
authors.lastname: Barendregt
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Y Claire
authors.initials: YC
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000329:Advertising; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D063766:Pediatric Obesity / Q000191:economics* / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D013690:Television; D014481:United States; D055815:Young Adult