title: Costs and effects of a state-wide health promotion program in primary schools in Germany - the Baden-Württemberg Study: A cluster-randomized, controlled trial.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program "Join the Healthy Boat" in primary schools in Germany.
  
  
  METHODS
  Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated.
  
  
  RESULTS
  The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group.
  
  
  CONCLUSIONS
  This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases.
  
  
  BACKGROUND
  German Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: DRKS00000494.
authors.affiliation: Section Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University, Ulm, Germany.|Institute of General Medicine, Ulm University, Ulm, Germany.
authors.forename: Dorothea
authors.identifier: http://orcid.org/0000-0002-2166-846X
authors.initials: D
authors.lastname: Kesztyüs
authors.affiliation: Section Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University, Ulm, Germany.
authors.forename: Romy
authors.initials: R
authors.lastname: Lauer
authors.affiliation: Department of Computer Science, Ulm University of Applied Sciences, Ulm, Germany.
authors.forename: Tibor
authors.initials: T
authors.lastname: Kesztyüs
authors.affiliation: Section Health Economics and Health Services Research, Department of Psychiatry II, Ulm University, Günzburg, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kilian
authors.affiliation: Section Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University, Ulm, Germany.
authors.forename: Jürgen M
authors.initials: JM
authors.lastname: Steinacker
mesh_terms: D000328:Adult; D002648:Child; D002652:Child Behavior; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D004032:Diet; D005858:Germany; D015438:Health Behavior; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration; D006801:Humans; D015994:Incidence; D008019:Life Style; D056128:Obesity, Abdominal / Q000453:epidemiology / Q000517:prevention & control*; D010290:Parents; D015397:Program Evaluation; D012572:School Health Services / Q000191:economics / Q000458:organization & administration; D000070777:School Teachers; D012574:Schools; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D000070260:Teacher Training / Q000191:economics / Q000458:organization & administration; D065927:Waist-Height Ratio