An Economic Evaluation of the Expanded Food and Nutrition Education Program

ObjectiveTo evaluate the New York State Expanded Food and Nutrition Education Program using economic methodology.DesignData 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.SettingCooperative Extension, 35 counties.Participants5730 low-income participants.InterventionSeries of 6 or more food and nutrition lessons.Main outcome measuresCost (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.AnalysisCost-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.ResultsCost was $892/graduate. Cost-effectiveness was 245 QALYs saved, at $20 863/QALY (sensitivity 42-935 QALYs, $5467-$130 311 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 implicationsOutcome 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.