title: Cost-effectiveness of a Nutrition Education Curriculum Intervention in Elementary Schools.
abstract: To estimate the long-term cost-effectiveness of an obesity prevention nutrition education curriculum (Food, Health, & Choices) as delivered to all New York City fifth-grade public school students over 1 year.
  
  
  
  This study is a standard cost-effectiveness analysis from a societal perspective, with a 3% discount rate and a no-intervention comparator, as recommended by the US Panel on Cost-effectiveness in Health and Medicine. Costs of implementation, administration, and future obesity-related medical costs were included. Effectiveness was based on a cluster-randomized, controlled trial in 20 public schools during the 2012-2013 school year and linked to published estimates of childhood-to-adulthood body mass index trajectories using a decision analytic model.
  
  
  
  The Food, Health, & Choices intervention was estimated to cost $8,537,900 and result in 289 fewer males and 350 fewer females becoming obese (0.8% of New York City fifth-grade public school students), saving 1,599 quality-adjusted life-years (QALYs) and $8,098,600 in direct medical costs. Food, Health, & Choices is predicted to be cost-effective at $275/QALY (95% confidence interval, -$2,576/QALY to $2,084/QALY) with estimates up to $6,029/QALY in sensitivity analyses.
  
  
  
  This cost-effectiveness model suggests that a nutrition education curriculum in public schools is effective and cost-effective in reducing childhood obesity, consistent with the authors' hypothesis and previous literature. Future research should assess the feasibility and sustainability of scale-up.
authors.affiliation: Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY. Electronic address: mmg2198@tc.columbia.edu.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Graziose
authors.affiliation: Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Koch
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Y Claire
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY.
authors.forename: Heewon
authors.initials: H
authors.lastname: Lee Gray
authors.affiliation: Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY.
authors.forename: Isobel R
authors.initials: IR
authors.lastname: Contento
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006266:Health Education / Q000191:economics* / Q000379:methods*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009519:New York City / Q000453:epidemiology; D052756:Nutritional Sciences / Q000193:education*; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control; D012574:Schools
keywords: QALYs; children; cost-effectiveness; economic modeling; nutrition education