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Now let's look at a specific health issue - obesity. The total costs attributable to obesity-related disease are approaching $100 billion annually in the United States. Your organization's health questionnaire measures, among other items, body mass index (BMI). Results show 1,000 obese individuals among those surveyed. You are charged with the task of choosing a solution to help these individuals lose weight.

You narrow your choices to providing 1) print brochures, 2) a web-based tailored behavior change intervention, 3) a health advice line, or 4) personal face-to-face counseling. Given the values in the table below, you estimate the cost effectiveness of each of the four approaches using an average price of the intervention.

INTERVENTION Reach Impact
Print Brochure 40% 0%-4%
Tailored Web Product 20% 10%-20%
Health Advice Line 5% 5%-15%
Personal Counseling 1% 17%-30%
Print brochures:
  • 1,000 individuals
  • Reach: 40% x 1,000 = 400 individuals read the brochure
  • Cost: $3 per participant x 400 = $1,200
  • Impact: 4% x 400 = 16 participants lose weight
  • Cost effectiveness: $75 per participant who lost weight
Tailored web-based product:
  • 1,000 individuals
  • Reach: 20% x 1,000 = 200 individuals enroll and complete program
  • Cost: $10 per participant x 200 = $2,000
  • Impact: 20% x 200 = 40 participants lose weight
  • Cost effectiveness: $50 per participant who lost weight
Health advice lines:
  • 1,000 individuals
  • Reach: 5% x 1,000 = 50 individuals call the line
  • Cost: $92 per participant x 50 = $4,600
  • Impact: 15% x 50 = 7.5 participants lose weight
  • Cost effectiveness: $613 per participant who lost weight
Personal Face-to-Face Counseling:
  • 1,000 individuals
  • Reach: 1% x 1,000 = 10 individuals participate
  • Cost: $300 per participant x 10 = $3,000
  • Impact: 30% x 10 = 3 participants lose weight
  • Cost effectiveness: $1,000 per participant who lost weight


Cost-Effectiveness Comparison

of Public Health Obesity Programs in a population of 1,000



 Percent
Reached
 Number
Reached
 Cost Per
Person
 Total
Cost
 Percent
Changing
 Number
Changing
 Cost-
Effectiveness
Print Brochure
 40% 400 $3 $1,200 4% 16 $75
Tailored Web
 20% 200 $10 $2,000 20% 40
 $50
Phone Advice
 5% 50 $92 $4,600 15% 7.5 $613
Personal Counseling
 1% 10 $300 $3,000 30% 3 $1,000

The decision to use a health promotion program is not determined on cost effectiveness alone. It can be evaluated on several different fronts including, process measures (e.g., participation rates), impact measures (e.g., immediate behavior change), and long term outcome measures (e.g., sustained behavior change, reduction in incidence of disease, and cost benefit to the organization). This type of comparison can be valuable to a program planner because it illustrates the balance that exists between being able to reach a high number of people while at the same time offering an effective, affordable program that will continue to translate into net cost savings for an organization.

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