The Cost-effectiveness of Australia's Active After-school Communities Program

The objective of this study was to assess from a societal perspective the cost‐effectiveness of the Active After‐school Communities (AASC) program, a key plank of the former Australian Government's obesity prevention program. The intervention was modeled for a 1‐year time horizon for Australian primary school children as part of the Assessing Cost‐Effectiveness in Obesity (ACE‐Obesity) project. Disability‐adjusted life year (DALY) benefits (based on calculated effects on BMI post‐intervention) and cost‐offsets (consequent savings from reductions in obesity‐related diseases) were tracked until the cohort reached the age of 100 years or death. The reference year was 2001, and a 3% discount rate was applied. Simulation‐modeling techniques were used to present a 95% uncertainty interval around the cost‐effectiveness ratio. An assessment of second‐stage filter criteria (“equity,” “strength of evidence,” “acceptability to stakeholders,” “feasibility of implementation,” “sustainability,” and “side‐effects”) was undertaken by a stakeholder Working Group to incorporate additional factors that impact on resource allocation decisions. The estimated number of children new to physical activity after‐school and therefore receiving the intervention benefit was 69,300. For 1 year, the intervention cost is Australian dollars (AUD) 40.3 million (95% uncertainty interval AUD 28.6 million; AUD 56.2 million), and resulted in an incremental saving of 450 (250; 770) DALYs. The resultant cost‐offsets were AUD 3.7 million, producing a net cost per DALY saved of AUD 82,000 (95% uncertainty interval AUD 40,000; AUD 165,000). Although the program has intuitive appeal, it was not cost‐effective under base‐case modeling assumptions. To improve its cost‐effectiveness credentials as an obesity prevention measure, a reduction in costs needs to be coupled with increases in the number of participating children and the amount of physical activity undertaken.