Table 1.
Cost-effectiveness results for selected interventions evaluated in Australia
| Intervention | Target population | Strength of evidence1 1=strongest |
DALYs2 saved |
Gross costs3 (AUD4 million) |
Net cost per DALY saved5 (AUD3 million) |
|---|---|---|---|---|---|
| Unhealthy food and beverage tax (10%)*84 | Adults | 4 | 170,000 | 1 | Cost-saving6 |
| Reduction of advertising of ‘junk food and beverages to children’# | Children age 0– 14 | 2 | 37,000 | 0.13 | Cost-saving |
| Front-of-pack traffic light nutrition labelling*84 | Adults | 5 | 32,000 | 4 | Cost-saving |
| School-based education program to reduce TV viewing# | Primary school children (8–10) | 3 | 8,600 | 27.7 | Cost-saving |
| Multi-faceted school-based program including nutrition and physical activity# | Primary school children (age 6) | 3 | 8,000 | 40 | Cost-saving |
| School-based education program to reduce sugar sweetened drink consumption# | Primary school children (7–11) | 3 | 5,300 | 3.3 | Cost-saving |
| Family based targeted program for obese children# | Obese children (ages 10–11) | 1 | 2,700 | 11 | Cost-saving |
| Multi-faceted targeted school-based program# | Overweight/obese primary school children (ages 7–10) | 3 | 270 | 0.56 | Cost-saving |
| Gastric banding - adolescents#113 | Severely obese adolescents (ages 14–19) | 1 | 12,300 | 130 | 4,400 |
| Family-based GP-mediated program#114 | Overweight/ moderately obese children (ages 5–9) | 3 | 510 | 6.3 | 4,700 |
| Gastric banding – adults* | Adults BMI>35 | 1 | 140,000 | 120 | 5,800 |
| Multi-faceted school-based program without an active physical activity component# | Primary school children (age 6) | 3 | 1,600 | 51.2 | 21,300 |
| Diet and exercise* | Adults BMI >25 | 1 | 3,000 | 140 | 28,000 |
| Low fat diet* | Adults BMI>25 | 1 | 1,900 | 94 | 37,000 |
| Active After Schools Communities Program#115 | Primary school children (5–11) | 5 | 450 | 40.3 | 82,000 |
| Weight Watchers* | Adults | 1 | 54 | 5 | 84,000 |
| Lighten Up to a Healthy Lifestyle weight loss program* | Adults | 4 | 38 | 4 | 94,000 |
| TravelSMART Schools# | Primary school children (ages 10–11) | 4 | 90 | 13.1 | 117,000 |
| Orlistat* | Adults BMI>30 | 1 | 2,100 | 1,500 | 700,000 |
| Walking School Bus# | Primary school children (ages 5–7) | 3 | 450 | 40.3 | 760,000 |
Interventions drawn from ACE-Prevention study 2010.74
Interventions drawn from Ace-Obesity study.73
This classification (1 = strongest; 5 = weakest) is based on criteria adopted in ACE-Prevention.74 1) ‘Sufficient evidence of effectiveness’ Effectiveness is demonstrated by sufficient evidence from well-designed research that the effect: is unlikely to be due to chance (e.g. p<0.05); and is unlikely to be due to bias, e.g. evidence from: a level I study design; several good quality level II studies; or several high quality level III-1 or III-2 studies from which effects of bias and confounding can be reasonably excluded on the basis of the design and analysis. 2) ‘Likely to be effective’ Effectiveness results are based on: sound theoretical rationale and program logic; and level IV studies, indirect or parallel evidence for outcomes; or epidemiological modeling to the desired outcome using a mix of evidence types or levels. The effect is unlikely to be due to chance. Implementation of this intervention should be accompanied by an appropriate evaluation budget. 3) ‘Limited evidence of effectiveness’ is demonstrated by limited evidence from studies of varying quality (can be level II or II studies) 4) ‘May be effective’ is similar to 2) but with potential lack of significance and confounding. 5) inconclusive or inadequate evidence (5 or 6 in original studies).
DALYs = Disability-adjusted life years saved which combine premature death (years of life lost) and morbidity (years lived with a disability)
Gross costs = intervention costs
AUD = Australian dollars (1 AUD=0.998 US)
Net cost per DALY saved = Gross costs minus cost offsets divided by number of DALYs saved
Cost-saving = achieves both health gain and cost savings (“dominant”)