Abstract
OBJECTIVE: Behavioural interventions can be delivered via online school canteens to improve healthy purchasing for students. However, no evaluations of the cost or cost-effectiveness of online canteen interventions have been conducted. The objective was to conduct a cost and cost-effectiveness analysis of implementing an online school canteen intervention to improve healthy purchasing. SETTING: The 'Click & Crunch' cluster randomised controlled trial was conducted in seventeen Australian primary schools. PARTICIPANTS: Eight control schools (848 students) received the standard online canteen. Nine intervention schools (1359 students) received a behavioural intervention delivered through the online canteen. DESIGN: Incremental cost-effectiveness ratios (ICER) were calculated for the cost per student to achieve (1) a unit decrease in the mean energy (kJ) content and (2) a percentage increase in the mean proportion of healthier 'Everyday' items purchased in their online lunch orders (from a health service and societal perspective). RESULTS: It costs AUD$568 per school (range $343-$806) to implement. The ICER for mean energy content was AUD$0·06 and AUD$0·46 for mean proportion of 'Everyday' foods (from a health perspective). At a willingness to pay of AUD$0·20 and AUD$1·20 per student, the intervention would have a 95 % and 99 % probability of being cost-effective for the energy (kJ) content and proportion of 'Everyday' items, respectively. CONCLUSIONS: 'Click & Crunch' has the potential to be a cost-effective intervention to reduce the energy content and increase the proportion of 'Everyday' items from primary school online canteen lunch orders.