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Dhillon A, Mayer M, Kysh L, Fox DS, Hegedus E, Vidmar AP. Cost-effectiveness analysis of individual-level obesity treatment in paediatrics: A scoping review. Pediatr Obes 2024; 19:e13100. [PMID: 38287524 DOI: 10.1111/ijpo.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES This scoping review informs a health economics perspective on the treatment of paediatric obesity. The results detail recently published research findings on the cost-effectiveness of paediatric obesity treatments and identify key characteristics of cost-effective interventions. METHODS A structured search was applied to six databases with no data restriction through March 2023: Medline, Embase, Cochrane CENTRAL, CINAHL, and PsycINFO. Studies that included a cost analysis of an individual level, weight management intervention (behavioural, pharmacotherapy, and surgical) in youth, with obesity, ages 2 to 21 years were eligible for inclusion. RESULTS Of the 4371 records identified in the initial search, 353 underwent full-text review, 39 studies met the pre-specified inclusion criteria. The majority were published after 2010 (n = 36/39, 92%) and applied to high-income countries (n = 39/39, 100%). Thirty-five of the studies assessed the cost-effectiveness of lifestyle interventions (90%), and four studies assessed surgical outcomes (10%). No pharmacotherapy studies met eligibility criteria. Although the outcome measures differed across the studies, all four surgical interventions were reported to be cost-effective. Thirty of the 35 (85%) lifestyle modification studies were reported to be cost-effective compared to the study comparator examined. CONCLUSIONS There is a small amount of evidence that individual-level paediatric obesity treatment interventions are cost-effective and, in some cases cost-saving, with most of this work conducted on behavioural interventions. The economic evaluation of paediatric obesity interventions poses various methodologic challenges, which should be addressed in future research to fully use the potential of economic evaluation as an aid to decision-making.
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Affiliation(s)
- Ashwin Dhillon
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Madeline Mayer
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Lynn Kysh
- Innovation Studio, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - D Steven Fox
- Department of Pharmaceutical and Health Economics, Mann School of Pharmacy of the University of Southern California, Los Angeles, California, USA
| | - Elizabeth Hegedus
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Alaina P Vidmar
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
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Atluri N, Thariath J, McEwen LN, Ye W, Song M, Herman WH. The effect of parental diabetes prevention program participation on weight loss in dependent children: a prospective cohort study. Clin Diabetes Endocrinol 2023; 9:8. [PMID: 38071328 PMCID: PMC10710703 DOI: 10.1186/s40842-023-00154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/25/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Obesity has reached epidemic proportions in children and adolescents in the United States. Children's behaviors are strongly influenced by parental behaviors, and weight loss in parents is positively associated with weight changes in their overweight/obese children. Research is limited on how parents' National Diabetes Prevention Program (DPP) participation affects the health outcomes of their dependent children. Analyzing the impact of parental DPP participation on weight loss in their dependent children may provide valuable insight into an important secondary benefit of DPP participation. METHODS In this study, we identified 128 adults with prediabetes who were offered the opportunity to participate in a DPP (n = 54 DPP participants and n = 74 DPP non-participants) and who had at least one child 3 to 17 years of age living with them. Age and BMI percentile for dependent children were collected from insurance claims data for 203 children (n = 90 children of DPP participants and n = 113 children of DPP non-participants). Parental practices related to diet and physical activity were assessed by surveys. RESULTS There were no significant changes in BMI percentiles of overweight or obese children (i.e. BMI percentile ≥ 50%) of DPP participants vs DPP non-participants with prediabetes over one-year. Parents who enrolled and did not enroll in the DPP did not report differences in their parenting practices related to diet and physical activity. DISCUSSION These results are not consistent with the literature that suggests parent-based interventions may influence their children's weight trajectories. Limitations include small sample size, short time span of intervention, and limited availability of additional health/biographic data on dependent children. Future studies should collect primary outcome data on children, investigate whether there is a minimum duration of parental involvement and level of parental adherence, and assess the effect of parent-child dynamics on child weight trajectories.
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Affiliation(s)
| | | | - Laura N McEwen
- Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 6108, Ann Arbor, MI, 48105, USA
| | - Wen Ye
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - MinKyoung Song
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - William H Herman
- Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 6108, Ann Arbor, MI, 48105, USA.
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Harris A, Jordan N, Carroll AJ, Graham AK, Wilson C, Wilson FA, Berkel C, Smith JD. A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI. Implement Sci Commun 2023; 4:59. [PMID: 37277878 DOI: 10.1186/s43058-023-00429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation. METHODS We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016-June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity-namely, ambulatory pediatric care clinicians-was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices. RESULTS The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1-15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333-$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524-$21,836 ($164-$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160-$94,208 ($497-$834 per family). CONCLUSIONS This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up. TRIAL REGISTRATION This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).
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Affiliation(s)
- Alexandra Harris
- Health Sciences Integrated PhD Program, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison J Carroll
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Fernando A Wilson
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, Spencer Fox Eccles School of Medicine, College of Social and Behavioral Science Department of Economics, Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA
| | - Cady Berkel
- Population Health & Integrated Behavioral Health, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Horning ML, Friend S, Freese RL, Barr-Anderson DJ, Linde JA, Sidebottom A, Sommerness SA, Fulkerson JA. Parent Weight, Diet, Active Living, and Food-Related Outcomes of the Family-Focused:NU-HOME Randomized Controlled Trial: NU-HOME Randomized Controlled Trial. J Acad Nutr Diet 2023; 123:751-760.e1. [PMID: 36244610 PMCID: PMC10097834 DOI: 10.1016/j.jand.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/12/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about parent outcomes of rural, family-focused childhood obesity prevention trials. OBJECTIVE Our aim was to evaluate parent outcomes of the rural, family-focused NU-HOME (New Ulm at HOME [Healthy Offerings via the Mealtime Environment]) randomized controlled trial designed to prevent obesity in children aged 7 through 10 years. DESIGN Families were randomized to the intervention or wait-list control group after baseline data collection. Staff measured parent height, weight, and percent body fat. Surveys measured parent cognitive and behavioral outcomes (eg, portion-size confidence, dietary intake, total and moderate-to-vigorous physical activity, and screen time). Post-intervention data were collected 8 to 10 months after baseline. PARTICIPANTS/SETTING The randomized controlled trial took place in rural, south central Minnesota, and enrolled parent and child dyads (N = 114; 2017-2018); 98 parents provided data at post intervention (2018-2019) and comprise the analytic sample. Parent inclusion criteria were being the primary meal preparer, living with the child most of the time, and being willing to attend intervention sessions. Exclusion criteria were planning to move or having a medical condition that would contraindicate participation. INTERVENTION The theory-guided intervention (7 sessions and 4 goal-setting calls) focused on family eating and active living behaviors. MAIN OUTCOME MEASURES Height, weight, and percent body fat were measured and the survey assessed diet, active living, and food-related outcomes. STATISTICAL ANALYSES PERFORMED Multiple linear regression models tested change in parent outcomes from baseline to post intervention by treatment group adjusted for demographic characteristics and baseline values. RESULTS In the intervention group vs control group, parent total weekly hours of physical activity was 1.73 hours higher (95% CI 0.11 to 3.35 hours) and portion-size confidence was 1.49 points higher (95% CI 0.78 to 2.19). No other statistically significant changes were observed by treatment group. CONCLUSIONS Findings indicate that parent cognitive and behavioral outcomes are amenable to change in family-focused childhood obesity prevention programs. Parent increases in portion-size confidence and total physical activity hours may support long-term parent health and provide positive context for child health.
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Affiliation(s)
| | - Sarah Friend
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca L Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | | | - Jennifer A Linde
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Jayne A Fulkerson
- Center for Child & Family Health Promotion Research, Clinical and Translational Science Institute Translational Research and Career Training TL1 Program and Translational Research Development Program, School of Nursing, University of Minnesota, Minneapolis
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Boutelle KN, Rhee KE, Manzano MA, Bernard RS, Strong DR, Eichen DM, Anderson CCA, Marcus BH, Akshoomoff N, Crow SJ. Design of the FRESH-DOSE study: A randomized controlled noninferiority trial evaluating a guided self-help family-based treatment program for children with overweight or obesity. Contemp Clin Trials 2023; 124:106996. [PMID: 36343880 PMCID: PMC9968239 DOI: 10.1016/j.cct.2022.106996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Michael A Manzano
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court Suite 102, San Diego, CA 92120, USA
| | - Rebecca S Bernard
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Cheryl C A Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, 121 South Main Street, box G-S121-3, Providence, RI 02912-G, USA
| | - Natacha Akshoomoff
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, F282/2A West 2450 Riverside Ave, Minneapolis, MN 55454, USA
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