Cost-effectiveness of community-based childhood obesity prevention interventions in Australia

Ananthapavan, Jaithri; Nguyen, Phuong; Bowe, Steven J.; Sacks, Gary; Herrera, Ana Maria Mantilla; Swinburn, Boyd; Brown, Vicki; Sweeney, Rohan; Lal, Anita; Strugnell, Claudia; Moodie, Marj

doi:10.1038/s41366-019-0341-0

Cited by 37 publications

(87 citation statements)

References 41 publications

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“…A proportional multi-state lifetable Markov model developed as part of an obesity priority setting study in Australia was used to estimate the obesity, transport injury and physical activity-related health outcomes and healthcare cost-savings over the life course of the population. Details on the model have been published elsewhere [19, 20].…”

Section: Methodsmentioning

confidence: 99%

Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia

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Scheurer

et al. 2019

Int J Behav Nutr Phys Act

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BackgroundPhysical inactivity is a global public health problem, partly due to urbanization and increased use of passive modes of transport such as private motor vehicles. Improving accessibility to public transport could be an effective policy for Governments to promote equity and efficiency within transportation systems, increase population levels of physical activity and reduce the negative externalities of motor vehicle use. Quantitative estimates of the health impacts of improvements to public transport accessibility may be useful for resource allocation and priority-setting, however few studies have been published to inform this decision-making. This paper aims to estimate the physical activity, obesity, injury, health and healthcare cost-saving outcomes of scenario-based improvements to public transport accessibility in Melbourne, Australia.MethodsBaseline and two hypothetical future scenario estimates of improved public transport accessibility for Melbourne, Australia, were derived using a spatial planning and decision tool designed to simulate accessibility performance (the Spatial Network Analysis for Multimodal Urban Transport Systems (SNAMUTS)). Public transport related physical activity was quantified by strata of age group and sex from Melbourne travel survey data (VISTA survey) and used with the SNAMUTS Composite Index to estimate input data for health impact modelling for the Melbourne population aged 20–74 years. A proportional multi-state, multiple cohort lifetable Markov model quantified the potential health gains and healthcare cost-savings from estimated changes in physical activity, body weight and injuries related to walking to access/egress public transport under two scenarios: (S1) public transport accessibility under current policy directions, and (S2) multi-directional, high-frequency network improvements.ResultsMulti-directional, high-frequency improvements to the public transport network (S2) resulted in significantly greater health and economic gains than current policy directions (S1) in relation to physical activity (mean 6.4 more MET minutes/week), body weight (mean 0.05 kg differential), health-adjusted life years gained (absolute difference of 4878 HALYs gained) and healthcare cost-savings (absolute difference of AUD43M), as compared to business as usual under both scenarios (n = 2,832,241 adults, over the lifecourse).ConclusionsBased on our conservative analyses, improving accessibility to public transport will improve population health by facilitating physical activity and lead to healthcare cost savings compared with business-as-usual. These wider health benefits should be better considered in transport planning and policy decisions.

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Section: Methodsmentioning

confidence: 99%

Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia

Brown

Barr

Scheurer

et al. 2019

Int J Behav Nutr Phys Act

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“…The Markov modelling approach is widely used in economic evaluations and can adequately capture the epidemiology and associated costs of chronic diseases associated with obesity [30]. Details of the model have been previously published [31] and are described here briefly.…”

Section: The Ace-obesity Policy Modelmentioning

confidence: 99%

Priority-setting for obesity prevention—The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study

et al. 2020

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The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for policy implementation. The Assessing Cost-Effectiveness (ACE) approach to priority-setting was used. Systematic literature reviews were undertaken to assess the evidence of intervention effectiveness on body mass index and/or physical activity for selected interventions. A standardised evaluation framework was used to assess the cost-effectiveness of each intervention compared to a 'no intervention' comparator, from a limited societal perspective. A multistate life table Markov cohort model was used to estimate the long-term health impacts (quantified as health adjusted life years (HALYs)) and health care cost-savings resulting from each intervention. In addition to the technical cost-effectiveness results, qualitative assessments of implementation considerations were undertaken. All 16 interventions evaluated were found to be cost-effective (using a willingness-to-pay threshold of AUD50,000 per HALY gained). Eleven interventions were dominant (health promoting and cost-saving). The incremental cost-effectiveness ratio for the non-dominant interventions ranged from AUD1,728 to 28,703 per HALY gained. Regulatory interventions tended to rank higher on their cost-effectiveness results, driven by lower implementation costs. However, the program-based policy interventions were generally based on higher quality evidence of intervention effectiveness. This comparative analysis of the economic credentials of obesity prevention policies for Australia indicates that there are a broad range of policies that are likely to be cost-effective, although policy options vary in strength of evidence for effectiveness, affordability, feasibility, acceptability to stakeholders, equity impact and sustainability.

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“…Future cost savings and benefits (HALYs) were discounted at 3% per year as per previous cost-effectiveness analyses for prevention interventions in Australia and are presented in 2010 values [5,14,31]. Incident cases of diseases saved were not discounted.…”

Section: Assessment Of Healthcare Cost Savingsmentioning

confidence: 99%

The Modelled Population Obesity-Related Health Benefits of Reducing Consumption of Discretionary Foods in Australia

et al. 2020

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Over one third of Australians’ daily energy intake is from discretionary foods and drinks. While many health promotion efforts seek to limit discretionary food intake, the population health impact of reductions in the consumption of different types of discretionary foods (e.g., sugar-sweetened beverages (SSBs), confectionery, sweet biscuits) has not been quantified. This study estimated the potential reductions in body weight, obesity-related disease incidence, and healthcare cost savings associated with consumption of one less serving per week of different discretionary foods. Reductions in the different types of discretionary food were modelled individually to estimate the impact on energy consumption and population body weight by 5-year age and sex groups. It was assumed that one serving of discretionary food each week was replaced with either a serving of fruit or popcorn, and a serving (375 mL) of SSBs was replaced with coffee, tea, or milk. Proportional multi-state multiple-cohort Markov modelling estimated likely resultant health adjusted life years (HALYs) gained and healthcare costs saved over the lifetime of the 2010 Australian population. A reduction of one serving of SSBs (375 mL) had the greatest potential impact in terms of weight reduction, particularly in ages 19–24 years (mean 0.31 kg, 95% UI: 0.23 kg to 0.37 kg) and overall healthcare cost savings of AUD 793.4 million (95% UI: 589.1 M to 976.1 M). A decrease of one serving of sweet biscuits had the second largest potential impact on weight change overall, with healthcare cost savings of $640.7 M (95% CI: $402.6 M to $885.8 M) and the largest potential weight reduction amongst those aged 75 years and over (mean 0.21 kg, 95% UI: 0.14 kg to 0.27 kg). The results demonstrate that small reductions in discretionary food consumption are likely to have substantial health benefits at the population level. Moreover, the study highlights that policy responses to improve population diets may need to be tailored to target different types of foods for different population groups.

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Cost-effectiveness of community-based childhood obesity prevention interventions in Australia

Cited by 37 publications

References 41 publications

Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia

Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia

Priority-setting for obesity prevention—The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study

The Modelled Population Obesity-Related Health Benefits of Reducing Consumption of Discretionary Foods in Australia

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