PUBH 6555-002 Topics In Health Economics

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PUBH 6555-002 Topics In Health Economics

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PUBH 6555-002 Topics In Health Economics

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Course Code: PUBH 6555-002
University: University Of Minnesota

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Country: United States


With the increase in the prevalence of obesity among children and adolescents over the past several decades in the United States and across the globe, researchers, medical providers, and governments worldwide are seeking novel methods to address this epidemic. The use of body mass index (BMI) report cards, where schools weigh and measure students and send parents an assessment of their child’s risk for obesity, is one method that has been popular across the United States and internationally. Experts agree that parents should be informed of their child’s weight status, yet there is considerable debate about how this information should be presented to parents and from whom it should come. Although several states have implemented BMI report card programs, few peer-reviewed studies evaluating their effectiveness have been published to date. Eating disorders, while less common than obesity, are prevalent among adolescents. Eating disorders are a source of substantial morbidity and mortality and are costly to treat. Early diagnosis and timely treatment could decrease the economic and health burden of eating disorders on the population. Although population-based screening for eating disorders has been validated as a feasible method to identify at-risk adolescents who might benefit from early identification and treatment, eating disorder screening has historically not been conducted as part of routine school-based health screenings in the United States. In March of 2013, Virginia Governor Bob McDonnell signed a bill that requires information about eating disorders to be sent to parents of Virginia public school students in grades 5-12. The law also calls for the Virginia Department of Health to work with the National Eating Disorders Association and other stakeholders to develop a plan for implementing eating disorder screenings in schools.
Suppose you are a health economist at the Virginia Department of Health, and is responsible for the cost-effectiveness analysis for this project.
Assume that the screenings will take place once a year. Evaluate the suggested intervention discussing the following key issues associated with the intervention:

The perspective of the study: Consider cost of obesity/eating disorder to theindividual with illness or to the society as a whole
The intervention time frame: The period should be sufficiently long to cover programstart-up phase and full program implementation (with ongoing costs and school schedule).
The analysis time frame: You need to decide how long we should wait to see changein outcome of interest if the intervention is successful. For prevention strategies, the time frame should capture all potential costs and benefits of the program. However, you must consider how realistic and feasible data collection will be (i.e., very few outcomes might be detectable within a short period after screening, but very long-term follow up is not feasible).
Data on all types of costs to be collected: including costs relating to actualimplementation of the treatments.
Data on relevant health outcomes within each of the following time frames: shortterm (e.g., one month), intermediate (e.g., one year), and long term (e.g., 10 years or lifetime). Rank the outcomes identified in (e) on the level of appropriateness for CEA. How feasible is it to obtain data on outcomes you have identified? If too difficult, what are the alternative outcomes that will still reflect the outcome of interest? What assumptions are you making regarding the alternatives as proxies for outcome of interest?

Outline the recommendations you would make? Support your analysis, evaluation, and recommendations through reference to the existing cost effectiveness literature.


Cost of the Study
The study involves student screening for school programme. The screening programme is supposed to focus on helping obese students. These are because the situation has caused to many people especially young people from the age of 6 years and to the society. The screening process is supposed to be positive according to the effectiveness of the type of therapy chosen. In this case, the group has decided to use the BMI method. The screening is useful since a recent study has shown that, obese individuals are likely to be infected with very chronic illnesses. These chronic illnesses include; hypertension, diabetes, asthma, Tb, and headlice. For school going children, such infections can be severe for them. The mass screening project has proved helpful to many schools. Therefore it can be the best method of dealing with obese children in school. Other health problems can be developed from obesity. Thus the screening process will be very significant.
The process will also involve public health authorities that will give the professional help in conducting the actual screening. The occupational health programme is supposed to determine the health efficiency and procedure effectiveness. They are supposed to determine the remediation ability to each of the students. The group will also determine the positive effect the screening program will have for each student. The public health monitors will also determine the level of information confidentiality that will be done during the screening program. The result of the BMI program has to reach the parents of the students of the school as a way of implementing the change of program for different children.
The school authority will help in providing choices for dietary interventions that can be used for students that will be found suffering from obese conditions. The school authority is also involved in defining a scope that will not interfere with the school routine and culture. The utility of school items can also be monitored by the school authority. The inclusivity of staff members that will provide an environment that is friendly and cool for the screening process to take place.
The implementation of this program is dependent on the mandate provided by the school mandate program. The school mandate program under the children and the maternal program focuses on various ways to help, the children who at risk of getting obese due dietary reasons. The programme, therefore, focuses on ways that help detect and monitor childhood overweight. The guidelines that will be used during the program are based on the Child Health Branch of the countries department of Health and Human service. The screening although focuses on Obese condition, will also detect other conditions that might be related to obesity. The group is hoping to achieve the health goals through involving the parents. The parents will be involved in the BMI health program. The BMI report will be submitted to parents during intervals. The parents being important stakeholder might want to opt out their children out of the program after sometimes.
Intervention time frame
The staff members of the group receive prior information about children in school for all the students supposed to undergo screening. There should be a proper parental agreement and consent within the first three months before the actual implementation since they form a more significant part of the parental consciousness program. The parental consent is therefore done before the measuring and weighing of the children.  The school provides an environment that is private. The school hall would probably be the best place. This is to help keep dignity, cultural need, and confidentiality of the individual undertaking the test during those designated times for the test.
The test can be taken during the evenings so that it doesn’t interfere with the standard learnings of the class schedules. All the equipment must be checked to ensure that they are error free. They are also to be checked so that they don’t cause any injury to the students. Their assembly must be done before the measurement so that they don’t scare the children off. Both the weighing and the measuring scale should be hidden from the view of both the children and other non-professionals. The child should be prepared psychological and be told of the test. Any anxiety should be treated professionally and sensitively. The children should not be coerced into the process. Any child under personal circumstances known by the school and the parents should be treated with care. The child may feel excluded, but proper explanations for each circumstance should make the child feel like the rest. At times measurement might be taken, but not recorded as accurate or not reported either.
To attain competency, the observation for each staff member should be a minimum of 5 for both height and weight measurements. The observed should also carry a same minimum number of both height and weight. For better results, the observation could be done annually with mentors. Peer observed practice could be done annually, and useful feedback relayed to the critical stakeholder.
Analysis Time Frame
Hours of intervention time frame depends on the ages of children found in the school. The primarily obese children will require up 75 hours of contact with a period ranging from six to twelve months depending on how they react to the behavioral intervention treatment. The hours of contact are also part of the proxy used for treatment. Weight outcomes are limited to six and twelve months since they are the beginning of the intervention unit, and the maintenance is short and within the first interventions outcomes that are observed.  Counseling of the weight loss takes up to 12 months up to the end of the actual intervention of the obese problem, which is the intervention method that takes the most extended period.
Low-intensity intervention methods are typically used for six months. The six months involve up to 25 contact hours. The contact hours should reduce with the improvement of age. Children aged up to 12 years and older will have reduced contact hours and short-term intervention for up to 6 months.  When submarine treatment is used as an intervention method for a younger population, the group takes less than six months for older children of up to the age of sixteen years. The intervention, however, has not been recommended for the younger children below the age of 6 years. As much as these could be the fastest intervention method taking a shorter time, it can’t be used in this case since there are younger children of that age within the school environment. Screening intervals vary about the condition for each child that will be tested for the first time. For extreme cases of overweight will require a shorter period of up to 3 months before undergoing another screening process. For those children of lesser weight will involve up to six months for another screening to take place.
The incorporation of parents for counseling as suggested will lead to longer and much time. The parents have to show commitment which will mean more time for the program.  Parental involvement is one of the vital components that might take up to six to twelve months depending on the seriousness of the parent. The trajectory of the parent might help in the status of the overall of the intentions of the child and the parent involved (Konnopka, Leichsenring, Leibing & König, 2009). Interventions that involve combining two methods for one individual have proven to take lesser times and longer accuracy depending on how they are combined. The use of counseling and drug methods tend to work very fast, and effects are realized as early as three months. Use of BMI method and counseling might take up to six months so that the effect is ready to be seen. The modest combination of pharmacological agents with behavioral dietary intervention take shorter durations for children under the age of twelve. The problem only comes after if the drug use is stopped or there is a discontinuation of the drug system. The healing period, therefore, will be interfered with and might take a long time for up to 12 months, then the expected three months. The combination, therefore, should be followed strictly for the short term to be realized (Forman, Prokop, Keliher & Jacobs, 2008).
Cost collection and calculation
The estimated cost included the following critical areas. For the implementation of the program, the cost is compared to an implementation of another school with the current one. This implementation makes it easier to approximate what cost will be needed for ours. The first costs will be material cost. Tools like handbooks, nutrition, and physical activities materials must be included, dietary guideline materials and all the physical printing facilities that will be required for the program.
The second cost is the training cost. This is a cost that includes meeting rooms, training supplies for all the external trainers that shall have been invited to the program. These external trainers include all the people that have been invited into the program, for example, the public health group. Some of the trainers are also expected to participate in the preprogram training of these individuals. The other cost is communication and transport cost. Communication includes all the meetings that people and stakeholders of the program share their experience. These covers for the venues and snacks that might be used during the process. The process even gets more severe with the use and implementation of a future intervention that will require constant communication between the members and the government stakeholders that will require constant feedback. Transport cost is from the internal traveling tickets for experts. The tickets are required both for the pre-training period and intervention period. The cost for transport administrators that may require taxi and other transport expenses (Wright, Austin, LeAnn Noh, Jiang & Sonneville, 2014).
Monitoring cost includes all the cost related to observation at each level. Monitoring is mostly done at the schools. Further monitoring might be required at the homes of the children where the parents will be. The cost can be summarized into three essential divisions. Money, labor and time investment cost. The evaluation of all this data can only be broken down during the beginning of the actual intervention period. The evaluation must be done and frequently revisited since it is difficult to predict the cost at their exact. Therefore, all this cost remains estimates.
Expected outcomes
There should be the difference in change for the overweight and obese prevalence. The achievement should hope to see an increment in BMI for the significant group and slightly lower in the control group. This will prove to us that the intervention has worked successfully. There is also expected outcome of the long-term study. After the 12 months, there should be a 1.8kg/m reduction of BMI for the child that has reduced the least. The panel expects inconsistent results these should be the least approximated result (Stuhldreher et al., 2012).
In results where the outcome will be the same. There would be a test for energy intake for external physical activities. Such cases should consider the possibility of an individual using part exercise for a short-term period of about two months. The average daily cost of energy will, therefore, be more than the magnitude proposed for the BMI and the childhood obesity. Parental intervention with high-intensity nutrition should also reflect. There should be a relation of the parental intervention though it is challenging to determine this parental intervention. Previous cases have not shown any relation of the parental intervention to any BMI and any other intervention though it has proven key to the intervention process (Nihiser et al., 2009).
The intervention should also reflect the cost outcome. The implemented solution should give a much lower monetary feedback than the one that has been put in. This will reflect perfect and accurate cost estimates. For combined intervention cases although they might reflect high cost. They should also show high effectiveness as expected since a lot shall have been invested in them regarding both labor and cost. Since it is difficult to convert BMI intervention measures into monetary terms, there isn’t much expected of the cost analysis.
Calculation and cost of intervention
Cost of intervention in the intervention schools (RMB (US dollars)).


Nutrition intervention

PA intervention

Nutrition & PA intervention










Money Costs










4414 (649.1)

2593 (381.3)

6544 (962.4)

6372 (937.1)

5774 (849.1)

5959 (876.3)

4204 (618.2)

28853 (4243.1)


3074 (452.1)

3074 (452.1)

3426 (503.8)

6914 (1016.8)

5427 (798.1 )

4351 (639.9)

5410 (795.6)

25528 (3754.1)


1453 (213.7)

1453 (213.7)

3309 (486.6)

5350 (786.8)

4480 (658.8)

3850 (566.2)

4470 (657.4)

21459 (3155.7)

Transportation and accommodation

7800 (1147.1)

7800 (1147.1)

1700 (250.0)

1080 (158.8)

5220 (767.6)

1300 (191.2)

3900 (573.5)

13200 (1941.2)


8300 (1220.6)

8300 (1220.6)

5100 (750.0)

800 (117.6)

1440 (211.8)

500 (73.5)

2000 (294.1)

9840 (1447.1)


25041 (3682.5)

23220 (3414.7)

20079 (2952.8)

20516 (3017.1)

22341 (3285.4)

15960 (2347.1)

19984 (2938.8)

98880 (14541.2)

Labor costs









School Intervention

10088 (1483.5)

10661 (1567.8)

95756 (14081.8)

87060 (12802.9)

235721 (34664.9)

66932 (9842.9)



The costs of development and evaluation of the program (RMB (US dollars) * ).


Main center

Other centers



Nutrition intervention

PA intervention


Nutrition & PA intervention

Development Costs






Money costs

0 (0)

1817 (267)

1817 (267)

0 (0)

2425 (357)

Labor costs

0 (0)

2952 (434)


0 (0)

24194 (3558 )


0 (0)



0 (0)


Evaluation Costs






Money costs subtotal

137510 (20222)

153010 (22501)

108310 (15928)

745904 (109692)

738978 (108673)


92592 (13616)

103792 (15264)

59592 (8764)

537372 (79025)

539311 (79310)


2546 (374)

729 (107)

729 (107)

22718 (3341)

14656 (2155)

Personnel allowance

12489 (1837)

15589 (2293)

15089 (2219)

119693 (17602)

119429 (17563)

Transport and accommodation

31800 (4676)

33000 (4853)

33000 (4853)

47057 (6920)

39217 (5767)

Collaborate fee

0 (0)

0 (0)

0 (0)

29250 (4301)

34126 (5019)

Labor costs

25691 (3778)

20503 (3015)

33563 (4936)

22801 (3353)

239636 (35241)

Total evaluation costs

163201 (24000)

173513 (25517)

141873 (20864)

768705 (113045)

978614 (143914)

Forman, S., Prokop, L. A., Keliher, A., & Jacobs, D. (2008). Screening High School Students for Eating Disorders: Results of a National Initiative. Preventing Chronic Disease, 5, 4.
Konnopka, A., Leichsenring, F., Leibing, E., & König, H. H. (2009). Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review. Journal of affective disorders, 114(1), 14-31.
Nihiser, A. J., Lee, S. M., Wechsler, H., McKenna, M., Odom, E., Reinold, C., … & Grummer-Strawn, L. (2009). BMI measurement in schools. Pediatrics, 124(Supplement 1), S89-S97.
Stuhldreher, N., Konnopka, A., Wild, B., Herzog, W., Zipfel, S., Löwe, B., & König, H. H. (2012). Cost?of?illness studies and cost?effectiveness analyses in eating disorders: A systematic review. International Journal of Eating Disorders, 45(4), 476-491.
Wright, D. R., Austin, S. B., LeAnn Noh, H., Jiang, Y., & Sonneville, K. R. (2014). The cost-effectiveness of school-based eating disorder screening. American journal of public health, 104(9), 1774-1782.

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