北京东城区儿童肥胖综合干预的成本效果

周双; 王迪; 高爱钰; 李钦; 刘峥; 王海俊

doi:10.16835/j.cnki.1000-9817.2022.11.005

北京东城区儿童肥胖综合干预的成本效果

doi: 10.16835/j.cnki.1000-9817.2022.11.005

周双¹,
王迪¹,
高爱钰²,
李钦¹,
刘峥^1, ,,
王海俊^1, ,

1.
北京大学公共卫生学院妇幼卫生系, 北京 100191
2.
北京市东城区中小学卫生保健所

基金项目:

国家自然科学基金项目 81973053

中华医学基金项目 11-064

详细信息

作者简介:
周双(1994-), 女, 辽宁鞍山人, 在读博士, 主要研究方向为儿童生长发育/肥胖流行病学

通讯作者:
刘峥, E-mail: liuzheng@bjmu.edu.cn

王海俊, E-mail: whjun@pku.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R 723.14 G 627.8 R 179
计量
- 文章访问数: 394
- HTML全文浏览量: 151
- PDF下载量: 40
- 被引次数: 0
出版历程
- 收稿日期: 2022-02-24
- 修回日期: 2022-03-18
- 网络出版日期: 2022-11-30
- 刊出日期: 2022-11-25

Cost-effectiveness analysis of comprehensive intervention for childhood obesity in Dongcheng District, Beijing

ZHOU Shuang¹,
WANG Di¹,
GAO Aiyu²,
LI Qin¹,
LIU Zheng^{1
, ,},
WANG Haijun^{1
, ,}

1.
Department of Maternal and Child Health, School of Public Health, Peking University, Beijing (100191), China

摘要

摘要: 目的评价以学校为基础的儿童肥胖综合干预的成本效果, 为制定并在大规模人群中推广高效、经济的儿童肥胖干预措施提供科学依据。方法采用整群随机对照试验的方法, 选取北京市东城区12所小学三至五年级1 889名学生, 随机分为干预组(6所小学930名学生)和对照组(6所小学959名学生)。对干预组学生进行为期1年的以学校为基础的儿童肥胖综合干预, 包括制定肥胖相关的学校政策、开展健康教育活动、加强体育锻炼、促进健康饮食。采用社会角度的成本分析方法, 评估干预项目的物资和人力成本。计算学生肥胖相关知识、每周不少于1 h中高等强度身体活动天数、摄入含糖饮料的学生比例的增量成本-效果比率。结果干预项目的物资成本为46 376.24元, 人力成本为46 197.32元, 合计为92 573.56元, 每名干预学生的人均成本为99.54元。学生肥胖相关知识的增量成本-效果比率为52.39%, 每周不少于1 h中高等强度身体活动天数的增量成本-效果比率为71.61%, 摄入含糖饮料的学生比例的增量成本-效果比率为2.26%。结论以学校为基础的儿童肥胖综合干预项目在增加学生肥胖相关知识及改善学生的饮食运动行为方面, 具有较好的成本效果。
- 肥胖症 /
- 干预性研究 /
- 成本及成本分析 /
- 儿童
Abstract: Objective To evaluate the cost-effectiveness of a school-based comprehensive intervention for childhood obesity and to provide scientific basis for formulating and promoting efficient and economic intervention measures for childhood obesity. Methods In a cluster randomized controlled trial, 12 primary schools (1 889 students from grade 3 to 5) in Dongcheng District in Beijing were selected and randomly assigned to the intervention (6 schools, 930 students) and control group (6 schools, 959 students). Students in the intervention group received a one-year school-based comprehensive intervention for childhood obesity, including development of school-level policies, health education activities, improvement of physical activity, and improvement of healthy diet. A cost analysis method from a social perspective was used to evaluate the implementation costs of the intervention. Cost-effectiveness analysis was used by calculating incremental cost-effectiveness ratio (ICER) on obesity-related knowledge, number of days completing no less than 60 minutes of moderate-to-vigorous physical activity (MVPA) per week, students consuming sugar-sweetened beverage. Results The material cost and human cost were 46 376.24 yuan and 46 197.32 yuan, respectively. The total cost of the intervention was 92 573.56 yuan and the average cost was 99.54 yuan per student in the intervention group. ICER on obesity-related knowledge, number of days completing no less than 60 minutes of MVPA per week, percentage of students consuming sugar-sweetened beverage were 52.39%, 71.61% and 2.26%, respectively. Conclusion The school-based comprehensive intervention for childhood obesity shows a good cost-effectiveness promoting students' obesity-related knowledge, as well as dietary and physical activity behaviors.
- Obesity /
- Intervention studies /
- Costs and cost analysis /
- Child
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 干预组不同物资干预成本情况

Table 1. Cost of different material in the intervention group

物资种类	物资明细	数量	单位	单价/元	小计/元
教师培训材料	控肥干预项目工作手册	12	本	2.80	33.60
	健康宣教活动策划方案	37	本	1.10	40.70
	儿童青少年有氧运动处方汇编	12	本	37.50	450.00
亲子学习材料	儿童怎样才能不肥胖	1 001	本	12.60	12 612.60
	以“健康饮食快乐运动”为主题的宣传折页、彩页等家长阅读材料	1 001	套	1.90	1 901.90
健康宣教活动用品	在学校和班级的宣传栏内张贴以减重控肥为主题的健康宣教海报	50	张	14.44	722.00
	主题班会教具，沙袋、薯片、火柴、酒精灯、甜味剂、食用色素、烧杯、玻璃棒、药盒、药匙等	12	套	147.47	1 769.64
	健康小报评比活动参与奖和优胜奖，荣誉证书、手抓球、羽毛球拍、板球拍、密码本、笔筒、橡皮等	420	份	20.44	8 586.40
体育锻炼活动用品	趣味运动体育器械，羊角球、跳跳球、速度球、呼啦圈、软梯、跳绳等	6	套	3 000.00	18 000.00
饮食运动行为监督	饮食运动行为日记表	1 001	份	1.60	1 601.60
	5-1-0-2-1达标自评贴画	6	份	80.00	480.00
	肥胖儿童运动饮食行为记录，运动俱乐部活动签到表、加饭登记表、体育锻炼1 h登记表	352	份	0.21	75.20
	肥胖儿童身高体重监测与反馈，个人体检表、结果反馈表、家长回执单	342	份	0.30	102.60
注：“5”代表每天吃5个普通成人拳头平均大小的蔬菜和水果；第1个“1”代表每天中高等强度体力活动时间达到1 h；“0”代表不喝含糖饮料；“2”代表每天看电视、玩电脑等静态活动时间(不包括上课时间)不超过2 h；第2个“1”代表每天吃肉不超过1份(1个普通成人手掌心平均大小)。

下载: 导出CSV

表 2 不同干预学校干预人力成本情况/元

Table 2. Human cost of the intervention in different intervention schools/yuan

干预校	校医	班主任	体育课指导人员	体育老师	健康教育授课人员	信息老师	校领导	膳食管理人员
1	3 558.33	2 417.49	1 056.38	1 002.86	365.67	446.94	142.21	40.22
2	2 148.75	3 792.40	1 056.38	1 535.75	264.10	137.52	122.30	74.60
3	5 219.92	3 798.91	1 056.38	108.98	446.93	189.09	155.61	108.98
4	1 226.33	1 588.23	1 056.38	132.02	284.41	103.14	210.06	108.98
5	2 662.39	1 929.93	1 056.38	1 266.56	406.30	292.23	155.61	74.60
6	1 758.88	521.28	1 056.38	401.21	277.50	68.76	135.30	177.74
合计	16 574.60	14 048.23	6 338.28	4 447.40	2 044.91	1 237.68	921.08	585.15

下载: 导出CSV

参考文献(16)

[1]	教育部体育卫生和艺术教育司. 第八次全国学生体质与健康调研结果发布[J]. 中国学校卫生, 2021, 42(9): 1281-1282. doi: 10.16835/j.cnki.1000-9817.2021.09.001 Department of Physical Health and Arts Education, Ministry of Education of the PRC. Release report of the eight national survey on student physical fitness and health[J]. Chin J Sch Health, 2021, 42(9): 1281-1282. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.09.001
[2]	WILLIAMS V, NUNAN D. Childhood obesity is associated with higher incidence of paediatric onset[J]. Evid Based Nurs, 2019, 22(4): 107. doi: 10.1136/ebnurs-2019-103062
[3]	PRAVEEN P A, TANDON N. Childhood obesity and type 2 diabetes in India[J]. WHO South East Asia J Public Health, 2016, 5(1): 17-21. doi: 10.4103/2224-3151.206547
[4]	ZHAO Y, WANG L, XUE B, et al. Associations between general and central obesity and hypertension among children: the childhood obesity study in China mega-cities[J]. Sci Rep, 2017, 7(1): 16895. doi: 10.1038/s41598-017-16819-y
[5]	UMER A, KELLEY G A, COTTRELL L E, et al. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with Meta-analysis[J]. BMC Public Health, 2017, 17(1): 683. doi: 10.1186/s12889-017-4691-z
[6]	PANDITA A, SHARMA D, PANDITA D, et al. Childhood obesity: prevention is better than cure[J]. Diabetes Metab Syndr Obes, 2016, 9: 83-89.
[7]	ZANGANEH M, ADAB P, LI B, et al. A systematic review of methods, study quality, and results of economic evaluation for childhood and adolescent obesity intervention[J]. Int J Environ Res Public Health, 2019, 16(3): 485. doi: 10.3390/ijerph16030485
[8]	LIU Z, LI Q, MADDISON R, et al. A school-based comprehensive intervention for childhood obesity in China: a cluster randomized controlled trial[J]. Child Obes, 2019, 15(2): 105-115. doi: 10.1089/chi.2018.0251
[9]	CULLEN K W, WATSON K, ZAKERI I. Relative reliability and validity of the Block Kids Questionnaire among youth aged 10 to 17 years[J]. J Am Diet Assoc, 2008, 108(5): 862-866. doi: 10.1016/j.jada.2008.02.015
[10]	HUNSBERGER M, O'MALLEY J, BLOCK T, et al. Relative validation of block kids food screener for dietary assessment in children and adolescents[J]. Matern Child Nutr, 2015, 11(2): 260-270. doi: 10.1111/j.1740-8709.2012.00446.x
[11]	刘爱玲, 马冠生, 张倩, 等. 小学生7天体力活动问卷信度和效度的评价[J]. 中华流行病学杂志, 2003, 24(10): 901-904. doi: 10.3760/j.issn:0254-6450.2003.10.013 LIU A L, MA G S, ZHANG Q, et al. Reliability and validity of a 7-day Physical Activity Questionnaire for Elementary Students[J]. Chin J Epidemiol, 2003, 24(10): 901-904. (in Chinese) doi: 10.3760/j.issn:0254-6450.2003.10.013
[12]	陈文, 应晓华, 刘杭生. 成本效果分析的成本测算[J]. 中国卫生资源, 2002, 5(4): 183-185. doi: 10.3969/j.issn.1007-953X.2002.04.017 CHEN W, YING X H, LIU H S. Estimating costs in cost-effectivness analysis[J]. Chin Health Res, 2002, 5(4): 183-185. (in Chinese) doi: 10.3969/j.issn.1007-953X.2002.04.017
[13]	XU H, LI Y, DU S, et al. Cost-utility and cost-benefit analyses of school-based obesity prevention program[J]. BMC Public Health, 2020, 20(1): 1608. doi: 10.1186/s12889-020-09718-x
[14]	赵力群, 郭红卫, 薛琨. 儿童肥胖的综合干预效果评价与成本效益分析[J]. 营养学报, 2014, 36(5): 426-429. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXX201405005.htm ZHAO L Q, GUO H W, XUE Q. Evaluation of the effect of comprehensive intervention and its cost-benefit analysis in children with obesity[J]. Acta Nutr Sinica, 2014, 36(5): 426-429. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-YYXX201405005.htm
[15]	LADAPO J A, BOGART L M, KLEIN D J, et al. Cost and cost-effectiveness of Students for Nutrition and Exercise (SNaX)[J]. Acad Pediatr, 2016, 16(3): 247-253.
[16]	BARRETT J L, GORTMAKER S L, LONG M W, et al. Cost effectiveness of an elementary school active physical education policy[J]. Am J Prev Med, 2015, 49(1): 148-159.