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Galekop MMJ, Uyl-de Groot C, Redekop WK. Economic Evaluation of a Personalized Nutrition Plan Based on Omic Sciences Versus a General Nutrition Plan in Adults with Overweight and Obesity: A Modeling Study Based on Trial Data in Denmark. PHARMACOECONOMICS - OPEN 2024; 8:313-331. [PMID: 38113009 PMCID: PMC10883904 DOI: 10.1007/s41669-023-00461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Since there is no diet that is perfect for everyone, personalized nutrition approaches are gaining popularity to achieve goals such as the prevention of obesity-related diseases. However, appropriate choices about funding and encouraging personalized nutrition approaches should be based on sufficient evidence of their effectiveness and cost-effectiveness. In this study, we assessed whether a newly developed personalized plan (PP) could be cost-effective relative to a non-personalized plan in Denmark. METHODS Results of a 10-week randomized controlled trial were combined with a validated obesity economic model to estimate lifetime cost-effectiveness. In the trial, the intervention group (PP) received personalized home-delivered meals based on metabolic biomarkers and personalized behavioral change messages. In the control group these meals and messages were not personalized. Effects were measured in body mass index (BMI) and quality of life (EQ-5D-5L). Costs [euros (€), 2020] were considered from a societal perspective. Lifetime cost-effectiveness was assessed using a multi-state Markov model. Univariate, probabilistic sensitivity, and scenario analyses were performed. RESULTS In the trial, no significant differences were found in the effectiveness of PP compared with control, but wide confidence intervals (CIs) were seen [e.g., BMI (-0.07, 95% CI -0.51, 0.38)]. Lifetime estimates showed that PP increased costs (€520,102 versus €518,366, difference: €1736) and quality-adjusted life years (QALYs) (15.117 versus 15.106, difference: 0.011); the incremental cost-utility ratio (ICUR) was therefore high (€158,798 to gain one QALY). However, a 20% decrease in intervention costs would reduce the ICUR (€23,668 per QALY gained) below an unofficial gross domestic product (GDP)-based willingness-to-pay threshold (€47,817 per QALY gained). CONCLUSION On the basis of the willingness-to-pay threshold and the non-significant differences in short-term effectiveness, PP may not be cost-effective. However, scaling up the intervention would reduce the intervention costs. Future studies should be larger and/or longer to reduce uncertainty about short-term effectiveness. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry (NCT04590989).
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Affiliation(s)
| | - Carin Uyl-de Groot
- Erasmus Universiteit Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - William Ken Redekop
- Erasmus Universiteit Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
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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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Sultana M, Nichols M, Moodie M, Allender S, Brown V. A systematic review of economic evidence for community-based obesity prevention interventions in children. Obes Rev 2023; 24:e13592. [PMID: 37308321 PMCID: PMC10909472 DOI: 10.1111/obr.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Multicomponent community-based obesity prevention interventions that engage multiple sectors have shown promise in preventing obesity in childhood; however, economic evaluations of such interventions are limited. This systematic review explores the methods used and summarizes current evidence of costs and cost-effectiveness of complex obesity prevention interventions. A systematic search was conducted using 12 academic databases and grey literature from 2006 to April 2022. Studies were included if they reported methods of costing and/or economic evaluation of multicomponent, multisectoral, and community-wide obesity prevention interventions. Results were reported narratively based on the Consolidated Health Economic Evaluation Reporting Standards. Seventeen studies were included, reporting costing or economic evaluation of 13 different interventions. Five interventions reported full economic evaluations, five interventions reported economic evaluation protocols, two interventions reported cost analysis, and one intervention reported a costing protocol. Five studies conducted cost-utility analysis, three of which were cost-effective. One study reported a cost-saving return-on-investment ratio. The economic evidence for complex obesity prevention interventions is limited and therefore inconclusive. Challenges include accurate tracking of costs for interventions with multiple actors, and the limited incorporation of broader benefits into economic evaluation. Further methodological development is needed to find appropriate pragmatic methods to evaluate complex obesity prevention interventions.
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Affiliation(s)
- Marufa Sultana
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
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Onyimadu O, Violato M, Astbury NM, Hüls H, Heath L, Shipley A, Taylor H, Wilkins LE, Abhari RE, Jebb SA, Petrou S. A systematic review of economic evaluations of interventions targeting childhood overweight and obesity. Obes Rev 2023; 24:e13597. [PMID: 37463862 DOI: 10.1111/obr.13597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 05/03/2023] [Accepted: 05/29/2023] [Indexed: 07/20/2023]
Abstract
This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.
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Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hannah Hüls
- The TUM School of Medicine, Technical University Munich, Munich, Germany
- The TUM School of Management, Technical University Munich, Munich, Germany
| | - Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alexandra Shipley
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | - Harriet Taylor
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | | | - Roxanna E Abhari
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Kohl J, Brame J, Centner C, Wurst R, Fuchs R, Sehlbrede M, Tinsel I, Maiwald P, Fichtner UA, Armbruster C, Farin-Glattacker E, Gollhofer A, König D. Effects of a Web-Based Lifestyle Intervention on Weight Loss and Cardiometabolic Risk Factors in Adults With Overweight and Obesity: Randomized Controlled Clinical Trial. J Med Internet Res 2023; 25:e43426. [PMID: 37368484 DOI: 10.2196/43426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The high proportion of people with overweight and obesity has become a worldwide problem in recent decades, mainly due to health consequences, such as cardiovascular diseases, neoplasia, and type 2 diabetes mellitus. Regarding effective countermeasures, the digitization of health services offers numerous potentials, which, however, have not yet been sufficiently evaluated. Web-based health programs are becoming increasingly interactive and can provide individuals with effective long-term weight management support. OBJECTIVE The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of an interactive web-based weight loss program on anthropometric, cardiometabolic, and behavioral variables and to compare it with a noninteractive web-based weight loss program. METHODS The randomized controlled trial included people who were aged between 18 and 65 years (mean 48.92, SD 11.17 years) and had a BMI of 27.5 to 34.9 kg/m2 (mean 30.71, SD 2.13 kg/m2). Participants (n=153) were assigned to either (1) an interactive and fully automated web-based health program (intervention) or (2) a noninteractive web-based health program (control). The intervention program focused on dietary energy density and allowed for dietary documentation with appropriate feedback on energy density and nutrients. The control group only received information on weight loss and energy density, but the website did not contain interactive content. Examinations were performed at baseline (t0), at the end of the 12-week intervention (t1), and at 6 months (t2) and 12 months (t3) thereafter. The primary outcome was body weight. The secondary outcomes were cardiometabolic variables as well as dietary and physical activity behaviors. Robust linear mixed models were used to evaluate the primary and secondary outcomes. RESULTS The intervention group showed significant improvements in anthropometric variables, such as body weight (P=.004), waist circumference (P=.002), and fat mass (P=.02), compared with the control group over the course of the study. The mean weight loss after the 12-month follow-up was 4.18 kg (4.7%) in the intervention group versus 1.29 kg (1.5%) in the control group compared with the initial weight. The results of the nutritional analysis showed that the energy density concept was significantly better implemented in the intervention group. Significant differences in cardiometabolic variables were not detected between the 2 groups. CONCLUSIONS The interactive web-based health program was effective in reducing body weight and improving body composition in adults with overweight and obesity. However, these improvements were not associated with relevant changes in cardiometabolic variables, although it should be noted that the study population was predominantly metabolically healthy. TRIAL REGISTRATION German Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3390/ijerph19031393.
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Affiliation(s)
- Jan Kohl
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Judith Brame
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Christoph Centner
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Ramona Wurst
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Reinhard Fuchs
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Matthias Sehlbrede
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Iris Tinsel
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Phillip Maiwald
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Urs Alexander Fichtner
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Armbruster
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Daniel König
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
- Department of Sport Science, Institute for Nutrition, Exercise and Health, University of Vienna, Vienna, Austria
- Department of Nutritional Sciences, Institute for Nutrition, Exercise and Health, University of Vienna, Vienna, Austria
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Carrello J, Hayes A, Baur LA, Lung T. Potential cost-effectiveness of e-health interventions for treating overweight and obesity in Australian adolescents. Pediatr Obes 2023; 18:e13003. [PMID: 36649693 PMCID: PMC10909552 DOI: 10.1111/ijpo.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/04/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND E-health, defined as the use of information and communication technologies to improve healthcare delivery and health outcomes, has been promoted as a cost-effective strategy to treat adolescent overweight and obesity. However, evidence supporting this claim is lacking. OBJECTIVES Assess the potential cost-effectiveness of a hypothetical e-health intervention for adolescents with overweight and obesity. METHODS The costs and effect size (BMI reduction) of the hypothetical intervention were sourced from recent systematic reviews. Using a micro-simulation model with a lifetime time horizon, we conducted a modelled cost-utility analysis of the intervention compared to a 'do-nothing' approach. To explore uncertainty, we conducted bootstrapping on individual-level costs and quality-adjusted life years (QALYs) and performed multiple one-way sensitivity analyses. RESULTS The incremental cost-effectiveness ratio (ICER) for the e-health intervention was dominant (cheaper and more effective), with a 96% probability of being cost-effective at a willingness-to-pay (WTP) of $50 000/QALY. The ICER remained dominant in all sensitivity analyses except when using the lower bounds of the hypothetical intervention effect size, which reduced the probability of cost-effectiveness at a WTP of $50 000/QALY to 51%. CONCLUSION E-health interventions for treatment of adolescent overweight and obesity demonstrate very good cost-effectiveness potential and should be considered by healthcare decision makers. However, further research on the efficacy of such interventions is warranted to strengthen the case for investment.
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Affiliation(s)
- Joseph Carrello
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Louise A. Baur
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- Weight Management Services, The Children's Hospital at WestmeadWestmeadAustralia
| | - Thomas Lung
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
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Kohl J, Brame J, Hauff P, Wurst R, Sehlbrede M, Fichtner UA, Armbruster C, Tinsel I, Maiwald P, Farin-Glattacker E, Fuchs R, Gollhofer A, König D. Effects of a Web-Based Weight Loss Program on the Healthy Eating Index-NVS in Adults with Overweight or Obesity and the Association with Dietary, Anthropometric and Cardiometabolic Variables: A Randomized Controlled Clinical Trial. Nutrients 2022; 15:7. [PMID: 36615666 PMCID: PMC9823428 DOI: 10.3390/nu15010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
This randomized, controlled clinical trial examined the impact of a web-based weight loss intervention on diet quality. Furthermore, it was investigated whether corresponding changes in diet quality were associated with changes in measures of cardiovascular risk profile. Individuals with a body mass index (BMI) of 27.5 to 34.9 kg/m2 and an age of 18 to 65 y were assigned to either an interactive and fully automated web-based weight loss program focusing on dietary energy density (intervention) or a non-interactive web-based weight loss program (control). Examinations were performed at baseline (t0), after the 12-week web-based intervention (t1), and after an additional 6 (t2) and 12 months (t3). Based on a dietary record, the Healthy Eating Index-NVS (HEI-NVS) was calculated and analyzed using a robust linear mixed model. In addition, bootstrapped correlations were performed independently of study group to examine associations between change in HEI-NVS and change in dietary, anthropometric, and cardiometabolic variables. A total of n = 153 participants with a mean BMI of 30.71 kg/m2 (SD 2.13) and an average age of 48.92 y (SD 11.17) were included in the study. HEI-NVS improved significantly in the intervention group from baseline (t0) to t2 (p = 0.003) and to t3 (p = 0.037), whereby the course was significantly different up to t2 (p = 0.013) and not significantly different up to t3 (p = 0.054) compared to the control group. Independent of study group, there was a significant negative association between change in HEI-NVS and dietary energy density. A higher total score in HEI-NVS did not correlate with improvements in cardiovascular risk profile. The interactive and fully automated web-based weight loss program improved diet quality. Independent of study group, changes in HEI-NVS correlated with changes in energy density, but there was no association between improvements in HEI-NVS and improvements in cardiovascular risk profile.
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Affiliation(s)
- Jan Kohl
- Department of Sport and Sport Science, University of Freiburg, 79117 Freiburg, Germany
| | - Judith Brame
- Department of Sport and Sport Science, University of Freiburg, 79117 Freiburg, Germany
| | - Pascal Hauff
- Department of Sport and Sport Science, University of Freiburg, 79117 Freiburg, Germany
| | - Ramona Wurst
- Department of Sport and Sport Science, University of Freiburg, 79117 Freiburg, Germany
| | - Matthias Sehlbrede
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Urs Alexander Fichtner
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christoph Armbruster
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Iris Tinsel
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Phillip Maiwald
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Reinhard Fuchs
- Department of Sport and Sport Science, University of Freiburg, 79117 Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, 79117 Freiburg, Germany
| | - Daniel König
- Department of Sport and Sport Science, University of Freiburg, 79117 Freiburg, Germany
- Department of Sport Science, Institute for Nutrition, Exercise and Health, University of Vienna, 1150 Vienna, Austria
- Department of Nutritional Sciences, Institute for Nutrition, Exercise and Health, University of Vienna, 1090 Vienna, Austria
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Brown V, Tran H, Williams J, Laws R, Moodie M. Exploring the economics of public health intervention scale-up: a case study of the Supporting Healthy Image, Nutrition and Exercise (SHINE) cluster randomised controlled trial. BMC Public Health 2022; 22:1338. [PMID: 35836222 PMCID: PMC9281014 DOI: 10.1186/s12889-022-13754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background The costs and benefits of an intervention within the intervention testing phase may differ from those experienced when that intervention is implemented and delivered at scale. Yet limited empirical work has been undertaken to explore how economic constructs related to implementation and scale-up might have an impact on intervention cost. The aim of this study was to explore the potential economic impacts of implementation and scale-up on a healthy weight and body image intervention tested in a Type II translational research trial. Methods The Supporting Healthy Image, Nutrition and Exercise (SHINE) study is a cluster randomised controlled trial, aiming to deliver universal education about healthy nutrition, physical activity and wellbeing behaviours to adolescents in Australian secondary schools. Data on the cost of the intervention were collected alongside the trial using standard micro-costing techniques. Semi-structured interviews were conducted with key intervention stakeholders to explore the potential economic impacts of implementation and scale-up. Thematic content analysis was undertaken by two authors. Results Fifteen intervention group schools participated in the 8-week online intervention targeting students in 2019 (99 Grade 7 classes; 2,240 students). Booster sessions were delivered during one class session in Grades 8 and 9, in 2020 and 2021 respectively. Time costs of intervention delivery and co-ordination comprised the majority (90%) of intervention cost as per the trial, along with costs associated with travel for intervention training and equipment. Themes related to the benefit of the intervention emerged from interviews with six intervention stakeholders, including the potential for economies of scale afforded by online delivery. Contextual themes that may have an impact on intervention implementation and scale included acceptability across all school sectors, availability and reliability of IT infrastructure for intervention delivery and variations in population characteristics. A number of key alterations to the intervention program emerged as important in supporting and sustaining intervention scale-up. In addition, significant implementation costs were identified if the intervention was to be successfully implemented at scale. Conclusions The findings from this study provide important information relevant to decisions on progression to a Type III implementation trial, including budget allocation, and will inform modelled economic evaluation.
Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13754-0.
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Affiliation(s)
- Vicki Brown
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia.
| | - Huong Tran
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia
| | - Joanne Williams
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Rachel Laws
- Deakin University, Geelong, Institute for Physical Activity and Nutrition, Victoria, 3220, Australia
| | - Marj Moodie
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia
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Mazéas A, Chalabaev A, Blond M, Pereira B, Duclos M. Digital intervention promoting physical activity among obese people (DIPPAO) randomised controlled trial: study protocol. BMJ Open 2022; 12:e058015. [PMID: 35710254 PMCID: PMC9204413 DOI: 10.1136/bmjopen-2021-058015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Physical inactivity and excessive sedentary behaviours are major preventable causes in both the development and the treatment of obesity and type 2 diabetes mellitus (T2DM). Nevertheless, current programmes struggle to engage and sustain physical activity (PA) of patients over long periods of time. To overcome these limitations, the Digital Intervention Promoting Physical Activity among Obese people randomised controlled trial (RCT) aims to evaluate the effectiveness of a group-based digital intervention grounded on gamification strategies, enhanced by social features and informed by the tenets of the self-determination theory and the social identity approach. METHODS AND ANALYSIS This trial is a two-arm parallel RCT testing the effectiveness of the Kiplin digital intervention on obese and patients with T2DM in comparison to the usual supervised PA programme of the University Hospital of Clermont-Ferrand, France. A total of 50 patients will be randomised to one of the two interventions and will follow a 3-month programme with a 6-month follow-up postintervention. The primary outcome of the study is the daily step count change between the baseline assessment and the end of the intervention. Accelerometer data, self-reported PA, body composition and physical capacities will also be evaluated. To advance our understanding of complex interventions like gamified and group-based ones, we will explore several psychological mediators relative to motivation, enjoyment, in-group identification or perceived weight stigma. Finally, to assess a potential superior economic efficiency compared with the current treatment, we will conduct a cost-utility analysis between the two conditions. A mixed-model approach will be used to analyse the change in outcomes over time. ETHICS AND DISSEMINATION The research protocol has been reviewed and approved by the Local Human Protection Committee (CPP Ile de France XI, No 21 004-65219). Results will inform the Kiplin app development, be published in scientific journals and disseminated in international conferences. TRIAL REGISTRATION NUMBER NCT04887077.
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Affiliation(s)
- Alexandre Mazéas
- SENS, Univ. Grenoble Alpes, 38000 Grenoble, France
- Department of Human Nutrition, INRAE Centre Clermont-Auvergne-Rhône-Alpes, Clermont-Ferrand, France
- Kiplin, Nantes, France
| | | | | | - Bruno Pereira
- Department of Biostatistics Unit (DRCI), University Hospital Centre, Clermont-Ferrand, France
| | - Martine Duclos
- Department of Human Nutrition, INRAE Centre Clermont-Auvergne-Rhône-Alpes, Clermont-Ferrand, France
- Department of Sport Medicine and Functional Exploration, University Hospital Centre, Clermont-Ferrand, France
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10
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Hesketh KD, Downing KL, Galland BC, Nicholson JM, Taylor R, Orellana L, Abdelrazek M, Koorts H, Brown V, Haines J, Campbell KJ, Barnett LM, Löf M, Moodie M, Carson V, Salmon J. Protocol for the Let's Grow randomised controlled trial: examining efficacy, cost-effectiveness and scalability of a m-Health intervention for movement behaviours in toddlers. BMJ Open 2022; 12:e057521. [PMID: 35351726 PMCID: PMC8961153 DOI: 10.1136/bmjopen-2021-057521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let's Grow mHealth intervention, designed to improve the composition of movement behaviours in children from 2 years of age. Let's Grow is novel in considering composition of movement behaviours as the primary outcome, using non-linear dynamical approaches for intervention delivery, and incorporating planning for real-world implementation and scale-up from its inception. METHODS AND ANALYSIS A randomised controlled trial will test the effects of the 12-month parental support mHealth intervention, Let's Grow, compared with a control group that will receive usual care plus electronic newsletters on unrelated topics for cohort retention. Let's Grow will be delivered via a purpose-designed mobile web application with linked SMS notifications. Intervention content includes general and movement-behaviour specific parenting advice and incorporates established behaviour change techniques. Intervention adherence will be monitored by app usage data. Data will be collected from participants using 24-hour monitoring of movement behaviours and parent report at baseline (T0), mid-intervention (T1; 6 months post baseline), at intervention conclusion (T2; 12 months post baseline) and 1-year post intervention (T3; 2 years post baseline). The trial aims to recruit 1100 families from across Australia during 2021. In addition to assessment of efficacy, an economic evaluation and prospective scalability evaluation will be conducted. ETHICS AND DISSEMINATION The study was approved by the Deakin University Human Ethics Committee (2020-077). Study findings will be disseminated through publication in peer-reviewed journals, presentation at scientific and professional conferences, and via social and traditional media. TRIAL REGISTRATION NUMBER ACTRN12620001280998; U1111-1252-0599.
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Affiliation(s)
- Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Katherine L Downing
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Liliana Orellana
- Faculty of Health Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Burwood, Victoria, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Victoria Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Lisa M Barnett
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- School of Health & Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Marie Löf
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
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11
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de Sousa D, Fogel A, Azevedo J, Padrão P. The Effectiveness of Web-Based Interventions to Promote Health Behaviour Change in Adolescents: A Systematic Review. Nutrients 2022; 14:nu14061258. [PMID: 35334915 PMCID: PMC8954163 DOI: 10.3390/nu14061258] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Although web-based interventions are attractive to researchers and users, the evidence about their effectiveness in the promotion of health behaviour change is still limited. Our aim was to review the effectiveness of web-based interventions used in health behavioural change in adolescents regarding physical activity, eating habits, tobacco and alcohol use, sexual behaviour, and quality of sleep. Studies published from 2016 till the search was run (May-to-June 2021) were included if they were experimental or quasi-experimental studies, pre-post-test studies, clinical trials, or randomized controlled trials evaluating the effectiveness of web-based intervention in promoting behaviour change in adolescents regarding those health behaviours. The risk of bias assessment was performed by using the Effective Public Health Practice Project (EPHPP)-Quality Assessment Tool for Quantitative Studies. Fourteen studies were included. Most were in a school setting, non-probabilistic and relatively small samples. All had a short length of follow-up and were theory driven. Thirteen showed significant positive findings to support web-based interventions' effectiveness in promoting health behaviour change among adolescents but were classified as low evidence quality. Although this review shows that web-based interventions may contribute to health behaviour change among adolescents, these findings rely on low-quality evidence, so it is urgent to test these interventions in larger controlled trials with long-term maintenance.
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Affiliation(s)
- Daniela de Sousa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.F.); (J.A.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
| | - Adriana Fogel
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.F.); (J.A.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
| | - José Azevedo
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.F.); (J.A.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Faculdade de Letras, Universidade do Porto, 4150-564 Porto, Portugal
| | - Patrícia Padrão
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.F.); (J.A.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal
- Correspondence: ; Tel.: +351-22-5074320
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12
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Tully L, Sorensen J, O'Malley G. Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial. JMIR Mhealth Uhealth 2021; 9:e31621. [PMID: 34519665 PMCID: PMC8479601 DOI: 10.2196/31621] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. OBJECTIVE We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). METHODS A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. RESULTS In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach. CONCLUSIONS This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. TRIAL REGISTRATION ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855.
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Affiliation(s)
- Louise Tully
- Obesity Research and Care Group, Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Grace O'Malley
- Obesity Research and Care Group, Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.,W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
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