An Economic Evaluation of the Expanded Food and Nutrition Education Program

Abstract 

Objective

To evaluate the New York State Expanded Food and Nutrition Education Program using economic methodology.

Design

Data were collected by nutrition educators in a pretest, posttest design with an epidemiological modeling approach to assess costs and estimate potential health benefits of the state program.

Setting

Cooperative Extension, 35 counties.

Participants

5730 low-income participants.

Intervention

Series of 6 or more food and nutrition lessons.

Main outcome measures

Cost (program and participant); health benefits in quality adjusted life years (QALYs); and monetized benefits: society's willingness to pay for QALYs, and benefits of avoiding or delaying health care costs and loss of productivity.

Analysis

Cost-effectiveness estimated from behavior change and QALY weights. Cost–benefit ratios estimated from costs and monetized benefits. Sensitivity analyses provided ranges where lack of agreement exists around parameters' values.

Results

Cost was $892/graduate. Cost-effectiveness was 245 QALYs saved, at $20863/QALY (sensitivity 42-935 QALYs, $5467-$130311 per QALY). Societal willingness to pay benefit-to-cost ratio was $9.58:$1.00 (sensitivity $1.44-$41.92:$1:00); narrow governmental benefit-to-cost ratio was $0.82:$1.00 (sensitivity $0.08-$4.33:$1:00).

Conclusions and implications

Outcome data indicate that food and nutrition behavior changes resulting from the Program are likely to improve future health and reduce health care costs. Cost-effectiveness is estimated to be as great as for many current health interventions.

Key Words: cost-benefit analysis, cost-effectiveness, evaluation studies, low-income population, nutrition education