Transcript An Average Cost Effectiveness Analysis of the EFNEP Effects

Utilizing National Data to Estimate
Average Cost Effectiveness of the
EFNEP Outcomes by State/Territory
1Ranju
Baral, PhD student
1,2Dr. George C. Davis, Professor
1 Department of Agricultural and Applied Economics
1,2 Department of Human Nutrition, Foods and Exercise
Virginia Tech
Objectives

Objective 1: Use national level data to calculate upper
limits on the average cost per participant and per
outcomes per state/territory

Objective 2: Utilize these upper limits on the average cost
to obtain more precise estimates for states based on the
state specific knowledge
Data
Costs: USDA’s
annual budget allocation for the EFNEP
Outcomes: USDA’s
Nutrition Education Evaluation and
Reporting System (NEERS) database
Ten behavioral checklists questions used by USDA to develop 3
indices




Food Resource Management Practices (FRMP)
Nutritional Practices (NP)
Food Safety Practices (FSP)
50 states and 6 US territories for the fiscal years 2000 to 2006
Methods
Average cost analysis
𝑇𝐶𝑖 (𝑦𝑒𝑎𝑟 2000 𝑡𝑜 2006)
𝐴𝐶𝑖𝑗 =
𝑦𝑖𝑗 (𝑦𝑒𝑎𝑟 2000 𝑡𝑜 2006)
where,
 ACij = is the average cost for the ith state/territory on the jth outcome
 TCi = the total cost of EFNEP for the ith state/territory
 yij = the “j”outcome of interest in state “i”
Outcomes (yij)
1. Total number of EFNEP participants
2. Expected number of EFNEP participants who improved in outcome
(a) FRMP
(b) NP
(c) FSP
Results: Summary Statistics of Costs and Outcomes Data
Aggregated Across the Years and States/Territories
Variable
Mean
Std. Dev.
1,109,010
914474.10
3,057
4330.78
1,799
2876.02
1,667
2750.00
1,815
2905.50
1,504
2479.11
1,468
2475.25
1,218
2060.34
Budget allocation
Number of participants
Number of participants who responded to FRMP
questions
Number of participants who responded to NP
questions
Number of participants who responded to FSP
questions
Number of participants who improved in one or
more FRMP questions
Number of participants who improved in one or
more NP questions
Number of participants who improved in one or
more FSP questions
Fig 1: Average Cost per Participant
Fig 2: Average Cost of Improving NP
Fig 3: Average Cost of Improving FRMP
Fig 4: Average Cost of Improving FSP
Extension 1 : Adjusted Average Cost Analysis
For example: Texas
The upper limit average cost (see figure 2, 3, and 4)
 FRMP = $162;
NP = $156; FSP = $198
Suppose, 70% of the budget is spent on the adult program and of this
70% budget devoted to
 FRMP = 30%;
NP =50%;
FSP = 20%
The adjusted average cost estimates then become
 FRMP = .70 × .30 × $162 = $34
 NP
= .70 × .50 × $156 = $55
 FSP
= .70 × .20 × $198 = $28
Extension 2: Calculation of Cost Effectiveness Ratio
Using Information from Dollahite et al. (2008) Paper
QALYk = [A] × [Bk] × [Ck] × [Dk] × [Ek]
Where,

QALY = Quality Adjusted Life Years

[A]
= Number of graduates

[Bk]
= Incidence rate of condition k

[Ck]
= Diet attributable risk for condition k

[Dk]
= Percentage of graduates practicing optimal nutrition behaviors related
to condition k

[Ek]
= Present value of QALYs saved for condition k
Extension 2: Calculation of Cost Effectiveness Ratio
Using Information from Dollahite et al. (2008) Paper
Conditions
Heart disease
Stroke
Hypertension
Colorectal cancer
Oestoporosis
Obesity
Diabetes
Foodborne illness
Low birthweight
Infants
Common infant
diseases
Total QALYs
Total cost
Cost per QALY saved
Cost inflated by 34%
Adjusted cost per
QALY
[A]
New York
5789
5789
5789
5789
5789
5789
5789
5789
[B]
[C]
[D]
[E]
QALY saved
New York
Iowa
1.13
0.30
3.11
0.84
145.18
39.04
0.38
0.10
20.54
5.52
31.72
8.53
7.14
1.92
23.15
6.23
Iowa
1556
1556
1556
1556
1556
1556
1556
1556
32
5
90
5.6
33
35.6
22
2.8
30
27
45
12
15
50
51
100
0.26
3.65
3.65
0.52
7.71
0.49
0.47
14.55
0.783
1.092
1.697
1.883
0.93
6.283
2.339
0.982
5789
1556
7.3
74
2.3
0.25
1.8
0.48
5789
1556
68
22
3.61
0.01
0.31
234.47
0.08
63.05
3244658
13838
5057869
861495
13664
1342923
21571
21301