Article Text

Download PDFPDF

Comparison of the ‘11+ Kids’ injury prevention programme and a regular warmup in children’s football (soccer): a cost effectiveness analysis
  1. Roland Rössler1,2,
  2. Evert Verhagen2,
  3. Nikki Rommers3,4,
  4. Jiri Dvorak5,
  5. Astrid Junge5,6,
  6. Eric Lichtenstein1,
  7. Lars Donath1,7,
  8. Oliver Faude1
  1. 1 Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
  2. 2 Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam, the Netherlands
  3. 3 Department of Movement and Sports Sciences, Vrije Universiteit Brussel, Brussels, Belgium
  4. 4 Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
  5. 5 Schulthess Klinik and Swiss Concussion Centre, Zurich, Switzerland
  6. 6 Medical School Hamburg, Hamburg, Germany
  7. 7 Departement of Intervention Research in Exercise Training, German Sport University, Cologne, Germany
  1. Correspondence to Dr Roland Rössler, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, CH-4052 Basel, Switzerland; roland.roessler{at}


Objective To evaluate a potential reduction in injury related healthcare costs when using the ‘11+ Kids’ injury prevention programme compared with a usual warmup in children’s football.

Methods This cost effectiveness analysis was based on data collected in a cluster randomised controlled trial over one season from football teams (under-9 to under-13 age groups) in Switzerland. The intervention group (INT) replaced their usual warmup with ‘11+ Kids’, while the control group (CON) warmed up as usual. Injuries, healthcare resource use and football exposure (in hours) were collected prospectively. We calculated the mean injury related costs in Swiss Francs (CHF) per 1000 hours of football. We calculated the cost effectiveness (the direct net healthcare costs divided by the net health effects of the ‘11+ Kids’ intervention) based on the actual data in our study (trial based) and for a countrywide implementation scenario (model based).

Results Costs per 1000 hours of exposure were CHF228.34 (95% CI 137.45, 335.77) in the INT group and CHF469.00 (95% CI 273.30, 691.11) in the CON group. The cost difference per 1000 hours of exposure was CHF−240.66 (95%CI −406.89, −74.32). A countrywide implementation would reduce healthcare costs in Switzerland by CHF1.48 million per year. 1002 players with a mean age of 10.9 (SD 1.2) years participated. During 76 373 hours of football, 99 injuries occurred.

Conclusion The ‘11+ Kids’ programme reduced the healthcare costs by 51% and was dominant (ie, the INT group had lower costs and a lower injury risk) compared with a usual warmup. This provides a compelling case for widespread implementation.

  • children
  • football
  • soccer
  • injury prevention
  • FIFA 11+ Kids

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors RR, EV and OF designed the study protocol. AJ and JD contributed to the design of the study. RR organised the study (ie, recruitment, data collection, quality control). EL contributed to study organisation. RR conducted the overall data management and organised the data preparation. EL contributed to the data preparation. RR analysed the data. RR and NR wrote the manuscript. RR, OF, EV and NR revised the manuscript. All authors contributed to reviewing and revising the manuscript, and agreed on the final draft.

  • Funding This study was supported by Fédération Internationale de Football Association and the University of Basel (grant: Top-Up Stipend).

  • Competing interests AJ was a member of the FIFA Medical Assessment and Research Centre (F-MARC). JD was chairman of F-MARC and consulting member of the FIFA Medical Committee until Autumn 2016.

  • Patient consent Not required.

  • Ethics approval The study was approved by Ethikkommission Nordwest- und Zentralschweiz, EKNZ (approval No 2014-232).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.