Cost-Effectiveness of 2 Support Models for a Healthy School Initiative

J Sch Health. 2020 Sep;90(9):724-730. doi: 10.1111/josh.12931. Epub 2020 Jul 21.


Background: In school year (SY) 2014-2015, 128 schools in 24 districts and 14 states were randomly assigned to receive either onsite or online support to implement a school-based wellness program. The objective of this study was to assess the cost-effectiveness (CE) of the 2 models of implementation support: onsite and online.

Methods: We adapted the "ingredients method" for the CE analysis. Using expenditure data, we tabulated the costs of relevant expense categories and allocated the appropriate proportion to determine the total costs of providing each type of support for 4 years (SY 2014-2015 through SY 2017-2018). We divided the average cost per school by the average change in school wellness policies and practices, using assessment data provided by the program provider, to calculate a CE ratio for schools in each group.

Results: Findings indicate that when the program is implemented as intended, online support is, on average, approximately 1.3 times more cost-effective than onsite support at the end of 4 years.

Conclusions: By demonstrating the relative CE of 2 approaches to supporting the implementation of a school health program, this study provides further insight on more efficient interventions for improving overall school wellness.

Keywords: childhood obesity; cost-effectiveness; elementary schools; healthy eating; organization and administration of school health programs; physical activity.

Publication types

  • Research Support, Non-U.S. Gov't