The Cost Effectiveness of a Free Summer Day Camp Voucher Program to Prevent Summer Weight Gain Among Children From Disadvantaged Households

Introduction

Summer day camps can mitigate summer weight gain by providing a structured daily environment that promotes healthy behaviors, but summer day camps are often cost prohibitive to families with low income. This study evaluated the cost effectiveness of providing free summer day camps to disadvantaged children to prevent summer weight gain.

Methods

A total of 422 children from a low-income school district in South Carolina were recruited and randomly assigned to receive 8–10 weeks of free summer day camps or to experience summer as usual in 2021–2023. The incremental cost-effectiveness ratio was calculated by dividing summer day camp cost by the difference between the intervention and control groups in changes in BMI z-scores from the start to end of summer. Incremental cost-effectiveness ratios at varied doses of summer day camp participation were also calculated. Sensitivity analyses were conducted using nonparametric bootstrapping of trial-based BMI z-score outcomes, matched with summer day camp costs from across the country. The probability of cost effectiveness was assessed over a range of potential costs at which policymakers may be willing to support.

Results

The summer day camp voucher program averted 0.0917 BMI z-score gain relative to the controls at a cost of $1,307, yielding an incremental cost-effectiveness ratio of $1,463 per 0.1 BMI z-score averted per child. Attending summer day camp 5 days per week, representing the highest dose, yielded the highest cost effectiveness. Sensitivity analyses showed that the bootstrapped incremental cost-effectiveness ratios averaged $2,187 per 0.1 BMI z-score averted, with 80% being <$3,500 per 0.1 BMI z-score averted.

Conclusions

The voucher program is likely cost effective, with 80% probability of cost effectiveness if policymakers are willing to pay $3,500 per 0.1 BMI z-score averted.