Economic evaluation of a multi-component obesity prevention intervention in Chinese primary schools

Health economic evaluations of childhood obesity interventions are critical for determining the economic feasibility, sustainability, and scalability, thereby informing their policy relevance. This study conducted a comprehensive economic evaluation of a multi-component, App-assisted obesity prevention intervention-compared with usual care-to assess its value for widespread implementation.

The Diet, Exercise, and Cardiovascular Health-Children (DECIDE-Children) intervention was a cluster randomized clinical trial involving 24 schools across three socioeconomically distinct regions in China, targeting children aged 8 to 10 years. Schools were randomly assigned (1:1) to either the intervention group or the control group (usual health education). The intervention included school, family, and student components supported by a mobile application for health education, behavior monitoring, weight management, and feedback. A societal perspective was adopted for the economic evaluation. Total costs included direct financial expenditures (e.g., materials, equipment) and labor costs. Incremental cost-effectiveness ratios (ICERs) were calculated for primary obesity-related outcome measure. Using an obesity progression model, we estimated the number of adult obesity cases prevented up to age 65, quality-adjusted life years (QALYs) gained, incremental cost-utility ratio (ICUR), cost-benefit ratio (CBR), and net benefits.

The total cost of implementing the 1-year intervention was 13,769.74 USD, averaging 19.53 USD per student in the intervention group. Compared with usual care, the ICERs were as follows: 42.46 USD (95% CI 29.15 to 78.12) per 1-unit reduction in BMI; 11.49 USD (95% CI 7.81 to 21.70) per 0.1-unit reduction in BMI Z-score; 18.60 USD (95% CI 10.67 to 69.75) per 1% reduction in body fat percentage; 11.98 USD (95% CI 6.93 to 45.42) per 1-cm reduction in waist circumference. The ICUR was 4644.42 USD per QALY gained, and the CBR was 0.84. National implementation was projected to yield 419,040 QALYs gained and USD 1.86 billion in net benefits. Sensitivity analyses supported the robustness of findings.

The DECIDE-Children intervention is a cost-effective strategy for childhood obesity prevention, providing significant public health and economic benefits. Its integration of school, family, and digital components offers a scalable, sustainable model for addressing childhood obesity in China and other developing settings.

ClinicalTrials.gov Identifier NCT03665857.