OBJECTIVE:To estimate lifetime cost effectiveness of lifestyle interventions to treat overweight and obese children, from the UK National Health Service perspective. DESIGN: An adaptation of the National Heart Forum economic model to predict lifetime health service costs and outcomes of lifestyle interventions on obesity-related diseases. SETTING: Hospital or community-based weight-management programmes. POPULATION: Hypothetical cohorts of overweight or obese children based on body mass data from the National Child Measurement Programme. INTERVENTIONS: Lifestyle interventions that have been compared with no or minimal intervention in randomized controlled trials (RCTs). MAIN OUTCOME MEASURES: Reduction in body mass index (BMI) standard deviation score (SDS), intervention resources/costs, lifetime treatment costs, obesity-related diseases and cost per life year gained. RESULTS: Ten RCTs were identified by our search strategy. The median effect of interventions versus control from these 10 RCTs was a difference in BMI SDS of À0.13 at 12 months, but the range in effects among interventions was broad (0.04 to À0.60). Indicative costs per child of these interventions ranged from d108 to d662. For obese children aged 10 --11 years, an intervention that resulted in a median reduction in BMI SDS at 12 months at a moderate cost of d400 increased life expectancy by 0.19 years and intervention costs were offset by subsequent undiscounted savings in treatment costs (net saving of d110 per child), though this saving did not emerge until the sixth or seventh decade of life. The discounted cost per life year gained was d13 589. Results were broadly similar for interventions aimed at children aged 4 --5 years and which targeted both obese and overweight children. For more costly interventions, savings were less likely. CONCLUSION: Interventions to treat childhood obesity are potentially cost effective although cost savings and health benefits may not appear until the sixth or seventh decade of life.
Objective To determine the potential cost savings resulting from the introduction of routine early medical abortion (EMA) at home by telemedicine in the UK.Design A costing study.Setting The UK.Population Women in 2020 undergoing EMA provided by three independent abortion providers and two National Health Service (NHS) abortion clinics.Methods Computation of the costs of each abortion procedure and of managing failed or incomplete abortion and haemorrhage requiring blood transfusion. Main outcome measures Cost savings.Results Overall estimated cost savings are £15.80 per abortion undertaken by independent abortion providers, representing a saving to the NHS of over £3 million per year. Limited data from NHS services resulted in an estimated average saving of £188.84 per abortion.Conclusions Were telemedicine EMA to become routine, an increase in the number of women eligible for medical rather than surgical abortion, and a reduction in adverse events resulting from earlier abortion, could result in significant cost savings.Keywords Abortion, economics of health care, termination of pregnancy.Tweetable abstract Early medical abortion at home using telemedicine could save the NHS £3 million per year.
ObjectiveTo determine the potential cost savings resulting from the introduction of routine early medical abortion at home by telemedicine in the United Kingdom.DesignA cost-effectiveness analysis Setting: United KingdomPopulationWomen in 2020 undergoing early medical abortion provided by three independent abortion providers and two NHS abortion clinics.MethodsComputation of the costs of each abortion procedure and of managing failed or incomplete abortion and haemorrhage requiring blood transfusion.Outcome measuresCost savingsResultsOverall estimated cost savings are £15.80 per abortion undertaken by independent abortion providers representing a saving to the NHS of over £3 million per year. Limited data from NHS services resulted in an estimated average saving of £188.84 per abortion.ConclusionsWere telemedicine EMA to become routine, an increase in the number of women eligible for medical rather than surgical abortion, and a reduction in adverse events resulting from earlier abortion could result in significant cost-savings.Tweetable AbstractEarly medical abortion at home using telemedicine could save the NHS £3 million per year
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