Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the food choice at work study

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dc.contributor.authorFitzgerald, Sarah
dc.contributor.authorMurphy, Aileen
dc.contributor.authorKirby, Ann
dc.contributor.authorGeaney, Fiona
dc.contributor.authorPerry, Ivan J.
dc.contributor.funderDepartment of Agriculture, Food and the Marine
dc.contributor.funderHealth Research Board
dc.date.accessioned2018-05-02T10:16:27Z
dc.date.available2018-05-02T10:16:27Z
dc.date.issued2018
dc.description.abstractObjective: To evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers. Design: Single-study economic evaluation of a cluster-controlled trial (Food Choice at Work (FCW) study) with 1-year follow-up. Setting: Four multinational manufacturing workplaces in Cork, Ireland. Participants: 517 randomly selected employees (18–65 years) from four workplaces. Interventions: Cost data were obtained from the FCW study. Nutrition education included individual nutrition consultations, nutrition information (traffic light menu labelling, posters, leaflets and emails) and presentations. System-level dietary modification included menu modification (restriction of fat, sugar and salt), increase in fibre, fruit discounts, strategic positioning of healthier alternatives and portion size control. The combined intervention included nutrition education and system-level dietary modification. No intervention was implemented in the control. Outcomes: The primary outcome was an improvement in health-related quality of life, measured using the EuroQoL 5 Dimensions 5 Levels questionnaire. The secondary outcome measure was reduction in absenteeism, which is measured in monetary amounts. Probabilistic sensitivity analysis (Monte Carlo simulation) assessed parameter uncertainty. Results: The system-level intervention dominated the education and combined interventions. When compared with the control, the incremental cost-effectiveness ratio (€101.37/quality-adjusted life-year) is less than the nationally accepted ceiling ratio, so the system-level intervention can be considered cost-effective. The cost-effectiveness acceptability curve indicates there is some decision uncertainty surrounding this, arising from uncertainty surrounding the differences in effectiveness. These results are reiterated when the secondary outcome measure is considered in a cost–benefit analysis, whereby the system-level intervention yields the highest net benefit (€56.56 per employee). Conclusions: System-level dietary modification alone offers the most value per improving employee health-related quality of life and generating net benefit for employers by reducing absenteeism. While system-level dietary modification strategies are potentially sustainable obesity prevention interventions, future research should include long-term outcomes to determine if improvements in outcomes persist.en
dc.description.sponsorshipIrish Health Research Board/Department of Agriculture, Fisheries and Food (HRB Centre for Health and Diet Research grant HRC2007/13)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide019182
dc.identifier.citationFitzgerald, S., Murphy, A., Kirby, A., Geaney, F. and Perry, I. J. (2018) 'Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the food choice at work study', BMJ Open, 8(3), e019182 (9pp). doi: 10.1136/bmjopen-2017-019182en
dc.identifier.doi10.1136/bmjopen-2017-019182
dc.identifier.endpage9
dc.identifier.issn2044-6055
dc.identifier.issued3
dc.identifier.journaltitleBMJ Openen
dc.identifier.startpage1
dc.identifier.urihttps://hdl.handle.net/10468/5950
dc.identifier.volume8
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttp://bmjopen.bmj.com/content/8/3/e019182
dc.rights© 2018, article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subjectFood choiceen
dc.subjectDietary modificationen
dc.subjectQuality of lifeen
dc.subjectNutritionen
dc.titleCost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the food choice at work studyen
dc.typeArticle (peer-reviewed)en
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