@article {570526,
	title = {Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S},
	journal = {Am J Prev Med},
	volume = {49},
	number = {1},
	year = {2015},
	month = {2015 Jul},
	pages = {135-47},
	abstract = {INTRODUCTION: Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities.

METHODS: Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention{\textquoteright}s impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3\% annually. Probabilistic sensitivity analyses simulated 95\% uncertainty intervals (UIs) around outcomes.

RESULTS: Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95\% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95\% UI=$14.2, $134) million. The intervention is 94.7\% likely to be cost saving by 2025.

CONCLUSIONS: Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.},
	keywords = {Child Care, Child Health, Child, Preschool, Cohort Studies, Cost-Benefit Analysis, Health Expenditures, Health Policy, Humans, Models, Economic, Obesity, United States},
	issn = {1873-2607},
	doi = {10.1016/j.amepre.2015.03.016},
	author = {Wright, Davene R and Kenney, Erica L and Giles, Catherine M and Long, Michael W and Ward, Zachary J and Resch, Stephen C and Moodie, Marj L and Carter, Robert C and Wang, Y Claire and Sacks, Gary and Swinburn, Boyd A and Gortmaker, Steven L and Cradock, Angie L}
}
