Economic evaluation of lifestyle interventions to treat overweight or obesity in children

Abstract

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.

Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents

“…Although more modest, significant improvements in weight and associated medical outcomes can still be made in adolescents, although additional research is warranted with this age group. Research also suggests that lifestyle interventions are probably cost-effective, although cost savings and health benefits may not be notable until the sixth or seventh decade of life (Hollingworth et al, 2012), with family-based treatment more cost-effective than treating parents and children separately . Additional research is needed to evaluate a stepped-care approach to treatment and further enhance the potency of treatments.…”

Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children

“…Nine of the studies [64][65][66][67][68][69][70][71][72] were published in 2012 or later, and of note in the current report is that the initial searching of the literature in 2012 was used as the basis for the conceptual modelling framework for HeLP, as set out below, and it was, therefore, based on a limited literature (as described below and in Table 26). However, a number of the more recent studies adopt the methodological framework used in the earlier literature, which has influenced the conceptual framework used for the HeLP-specific research.…”

“…Two models were identified. 62,63 Five models (reported in nine publications) were subsequently identified that were published between 2012 and 2015, [64][65][66][67]69 with the majority of these published in the last 2 years.…”

“…[62][63][64][65][66][67][68][69][70][71][72] The study identification process is summarised in Figure 5.…”

“…Most of the models identified in the review were from North America, 62,63,[67][68][69][70][71][72] with two European studies 64,65 (one being a multisite study across six countries in Europe 65 ) and one from New Zealand. 66 The studies varied in terms of the modelling approach used, the range of health states (including weight-related events) included in the models, the techniques used to predict weight status in adulthood as a function of childhood weight status and the outcomes included in the models.…”