Presentation (CTI)

OBJECTIVES: Physical inactivity—defined as not meeting the World Health Organization (WHO) recommended physical activity levels—remains a major public health challenge in France, with less than one-third of adolescents aged 11-14 meeting these recommendations. ICAPS (Intervention auprès des collégiens centrée sur l’activité physique et la sédentarité) is a multi-component, school-based intervention designed to promote sustained increases in physical activity among adolescents through environmental changes, social support, and educational activities. The objective of Santé publique France, the coordinator of the program evaluation, was to estimate the return on investment (ROI) of ICAPS.
METHODS: A cost-benefit analysis was conducted from a French healthcare payer perspective, using a lifetime horizon to capture long-term health and economic outcomes associated with changes in physical activity initiated during adolescence. A decision tree followed by a semi-Markov model with 14 mutually exclusive health states was developed to compare ICAPS with no intervention. Intervention effectiveness was derived from randomized controlled trial data and extended follow-up. Deterministic and scenario analyses were performed to test the robustness of results to key assumptions, including time horizon, persistence of intervention effects, and cost inputs.
RESULTS: In the base-case analysis, ICAPS generated a positive ROI, with €1.50 returned for every €1 invested. This reflects reductions in long-term healthcare costs driven by a lower incidence of chronic diseases associated with increased physical activity. Average lifetime cost savings were estimated at €421 per individual. Results were sensitive to assumptions, particularly the time horizon and duration of intervention effects: shorter horizons reduced ROI (approaching zero over an 8-year horizon), while inclusion of broader benefits increased estimated ROI (€29,59).
CONCLUSIONS: School-based physical activity programs such as ICAPS can improve adolescent health behaviors while generating long-term cost savings, supporting their large-scale implementation to prevent chronic diseases.