P143 Analyzing Costs Associated with Implementation of a Nutrition Program in Early Childhood Education


      Cost analysis is a tool used to summarize and report on individual elements of costs to implementing an innovation. We used cost analysis to track and compare costs of provision of 2 implementation strategies to support an evidence-based nutrition curriculum in the Head Start (HS) setting.


      To compare how much it cost, per classroom per year, to deliver the basic (ie, training and reminders) and enhanced implementation support (ie, a package of 8 implementation strategies).

      Study Design, Setting, Participants

      We partnered with a HS program in an urban area of a Southern state with 9 sites and 38 classrooms. We used stratified randomization to assign sites to participate in either the basic or the enhanced implementation of the nutrition curriculum. All sites received the same 6-hour training and implemented the curriculum with either basic or enhanced implementation support.

      Measurable Outcome/Analysis

      Cost accounting methods allowed for a comparison of time and materials allocated to each group. Our primary outcome of cost included fixed (eg, costs of trainings, materials, printing) and variable (eg, duration of facilitation, number of incentives, travel) costs for both strategies. Facilitators logged activities using a smartphone application.


      Estimated costs per classroom, per year were $35 for basic and $261 for enhanced implementation support. This reflects average delivery of 4 incentives and 2 resources per classroom, a total of 39.2 in-person and 20.4 virtual facilitation hours to enhanced classrooms. In-person facilitation accounted for 25% of the enhanced costs; travel 23%; and the tailored incentives and educational materials 21%.


      These data, paired with outcome data, will help understand the relative cost in improving implementation outcomes (eg, fidelity, acceptability) between groups, and will inform scalability and sustainability efforts for future uptake of the intervention.
      Funding USDA Lincoln Health; NIH.

      Appendix. Supplementary data