title: Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the 'Physical Activity 4 Everyone' cluster randomized trial.
abstract: BACKGROUND
  Few school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent populations. As a result, few cost effectiveness analyses have been reported. The aim of this paper is to report the cost and cost effectiveness of the Physical Activity 4 Everyone (PA4E1) intervention which was a multi-component intervention implemented in secondary schools located in low-income communities. Cost effectiveness was assessed using both the physical activity and weight status trial outcomes.
  
  
  METHODS
  Intervention and Study Design: The PA4E1 cluster randomised controlled trial was implemented in 10 Australian secondary schools (5 intervention: 5 control) and consisted of intervention schools receiving seven physical activity promotion strategies and six additional strategies that supported school implementation of the intervention components. Costs associated with physical activity strategies, and intervention implementation strategies within the five intervention schools were estimated and compared to the costs of usual physical activity practices of schools in the control group. The total cost of implementing the intervention was estimated from a societal perspective, based on the number of enrolled students in the target grade at the start of the intervention (Grade 7, n = 837). Economic Outcomes: The economic analysis outcomes were cost and incremental cost effectiveness ratios for the following: minutes of moderate-to-vigorous physical activity (MVPA) per day gained, MET hours gained per person/day; Body Mass Index (BMI) unit avoided; and 10% reduction in BMI z-score.
  
  
  RESULTS
  The intervention cost AUD $329,952 over 24 months, or AUD$394 per student in the intervention group. This resulted in a cost effectiveness ratio of AUD$56 ($35-$147) per additional minute of MVPA, AUD$1 ($0.6-$2.7) per MET hour gained per person per day, AUD$1408 ($788-$6,570) per BMI unit avoided, and AUD$563 ($282-$3,942) per 10% reduction in BMI z-score.
  
  
  CONCLUSIONS
  PA4E1 is a cost effective intervention for increasing the physical activity levels and reducing unhealthy weight gain in adolescence, a period in which physical activity typically declines. Additional modelling could explore the potential economic impact of the intervention on morbidity and mortality.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12612000382875.
authors.affiliation: Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, Australia, 2287. Rachel.Sutherland@hnehealth.nsw.gov.au.|School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia. Rachel.Sutherland@hnehealth.nsw.gov.au.|Hunter Medical Research Institute, Newcastle, NSW, Australia, 2305. Rachel.Sutherland@hnehealth.nsw.gov.au.
authors.forename: Rachel
authors.initials: R
authors.lastname: Sutherland
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW, Australia, 2305.
authors.forename: Penny
authors.initials: P
authors.lastname: Reeves
authors.affiliation: Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, Australia, 2287.|School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW, Australia, 2305.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Campbell
authors.affiliation: Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, Australia, 2308.
authors.forename: David R
authors.initials: DR
authors.lastname: Lubans
authors.affiliation: Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, Australia, 2308.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Morgan
authors.affiliation: Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, Australia, 2287.|School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW, Australia, 2305.
authors.forename: Nicole
authors.initials: N
authors.lastname: Nathan
authors.affiliation: Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, Australia, 2287.|School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW, Australia, 2305.
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfenden
authors.affiliation: Early Start Research Institute and School of Education, University of Wollongong, Wollongong, NSW, Australia, 2500.|Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia, 2522.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Okely
authors.affiliation: Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, Australia, 2287.|Hunter Medical Research Institute, Newcastle, NSW, Australia, 2305.
authors.forename: Karen
authors.initials: K
authors.lastname: Gillham
authors.affiliation: Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, Australia, 2287.|Hunter Medical Research Institute, Newcastle, NSW, Australia, 2305.
authors.forename: Lynda
authors.initials: L
authors.lastname: Davies
authors.affiliation: Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, Australia, 2287.|School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW, Australia, 2305.
authors.forename: John
authors.initials: J
authors.lastname: Wiggers
mesh_terms: D000293:Adolescent; D001315:Australia; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D015444:Exercise; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D009520:New Zealand; D009765:Obesity / Q000517:prevention & control*; D011203:Poverty; D012111:Residence Characteristics; D012572:School Health Services / Q000191:economics*; D012574:Schools; D013334:Students
keywords: Adolescents; Physical activity; Randomized controlled trial, Low income, Disadvantaged, Cost effectiveness, Economic; School