Summary: In a health-economic evaluation of the DECIDE-Children trial, a one-year multi-component, app-assisted obesity-prevention programme in Chinese primary schools was cost-effective, gaining a QALY for about USD 4,644 and reducing BMI, body fat, and waist circumference versus usual health education.
PICO Summary
| Element | Detail |
|---|---|
| Population | Children aged 8–10 across 24 primary schools in three socioeconomically distinct regions of China (cluster RCT). |
| Intervention | DECIDE-Children: 1-year school, family, and digital programme with a mobile app for education, behaviour tracking, and weight-management feedback. |
| Comparison | Usual care (standard school health education). |
| Outcome | Total cost USD 13,769.74 (USD 19.53/student). ICERs: USD 42.46 per 1-unit BMI reduction, USD 11.49 per 0.1 BMI Z-score, USD 18.60 per 1% body fat, USD 11.98 per 1 cm waist. ICUR USD 4,644.42 per QALY; cost-benefit ratio 0.84. Projected national rollout: 419,040 QALYs and USD 1.86 billion net benefit. Sensitivity analyses robust. |
Expert Commentary
Childhood obesity prevention lives or dies on whether anyone will actually fund it at scale, so a proper economic evaluation rather than another efficacy paper is genuinely welcome, and this one is methodologically thorough, with ICERs across several anthropometric outcomes, a QALY-based cost-utility figure, and sensitivity analyses. At under twenty dollars per student and roughly USD 4,644 per QALY, the programme looks comfortably cost-effective by most thresholds, and that is the headline I trust most. My caution is about what economic modelling inevitably involves: the long-term QALYs and the USD 1.86 billion national projection rest on an obesity-progression model extrapolating childhood anthropometry decades forward, and such models are only as good as their assumptions, however reassuring the sensitivity analyses. A cost-benefit ratio of 0.84 also means monetised benefits did not quite exceed costs on that particular metric, which the QALY framing softens. Can I use this with my patients? Not directly as a clinician, but it is solid ammunition for the public-health and policy case for integrated school-family-digital prevention, especially in comparable middle-income settings. I would want real-world budget-impact data from an actual rollout before treating the billion-dollar figure as anything more than a well-constructed projection.
References
Yan S, Zhou S, Guo X, et al. Economic evaluation of a multi-component obesity prevention intervention in Chinese primary schools. BMC Med. 2025;23(1):653. doi:10.1186/s12916-025-04451-x