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Candio P, Meads D, Hill AJ, Bojke L. Taking a local government perspective for economic evaluation of a population-level programme to promote exercise. Health Policy 2021; 125:651-657. [PMID: 33750575 DOI: 10.1016/j.healthpol.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/26/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In order to tackle the issue of physical inactivity, local governments have implemented population-level programmes to promote exercise. While evidence is accumulating on the cost-effectiveness of these interventions, studies have typically adopted a health sector perspective for economic evaluation. This approach has been challenged as it does not allow for key concerns by local governments, which are primary stakeholders, to be addressed. OBJECTIVES To show how taking a local government perspective for economic evaluation can be implemented in practice and this may affect the economic conclusions. METHODS Based on data from a case study, the health equity impact of the intervention and its opportunity cost from a service provider viewpoint were assessed. The cost-effectiveness implications of a change in perspective were subsequently estimated by means of scenario analysis. FINDINGS The intervention was found to provide adult residents living in the most deprived city areas with greater health benefits compared with the rest of the population. However, a negative net equity impact was found in the short-term. The opportunity cost of the intervention was estimated to be substantially lower than its financial cost (£2.77 per person/year), with significant implications for decision-making. CONCLUSIONS Taking a local government perspective can affect the conclusions drawn from the economic evaluation of population-level programmes to promote exercise, and therefore influence decision making.
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Affiliation(s)
- Paolo Candio
- Health Economics Research Centre, University of Oxford, 0X37LF Oxford, UK; Leeds Institute of Health Sciences, University of Leeds, LS29JT Leeds, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, LS29JT Leeds, UK
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, LS29JT Leeds, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, YO105DD Heslington, UK
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Yin Z, Ullevig SL, Sosa E, Liang Y, Olmstead T, Howard JT, Errisuriz VL, Estrada VM, Martinez CE, He M, Small S, Schoenmakers C, Parra-Medina D. Study protocol for a cluster randomized controlled trial to test "¡Míranos! Look at Us, We Are Healthy!" - an early childhood obesity prevention program. BMC Pediatr 2019; 19:190. [PMID: 31179916 PMCID: PMC6556954 DOI: 10.1186/s12887-019-1541-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One in three Head Start children is either overweight or obese. We will test the efficacy of an early childhood obesity prevention program, "¡Míranos! Look at Us, We Are Healthy!" (¡Míranos!), which promotes healthy growth and targets multiple energy balance-related behaviors in predominantly Latino children in Head Start. The ¡Míranos! intervention includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/education and home visits) interventions to address key enablers and barriers in obesity prevention in childcare. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy balance-related behaviors favorably in Head Start children. METHODS Using a three-arm cluster randomized controlled design, 12 Head Start centers will be randomly assigned in equal number to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) comparison. The interventions will be delivered by trained Head Start staff during the academic year. A total of 444 3-year-old children (52% females; n = 37 per center at baseline) in two cohorts will be enrolled in the study and followed prospectively 1 year post-intervention. Data collection will be conducted at baseline, immediately post-intervention, and at the one-year follow-up and will include height, weight, physical activity (PA) and sedentary behaviors, sleep duration and screen time, gross motor development, dietary intake and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected. DISCUSSION With endorsement and collaboration of two local Head Start administrators, ¡Míranos!, as a culturally tailored obesity prevention program, is poised to provide evidence of efficacy and cost-effectiveness of a policy and environmental approach to prevent early onset of obesity in low-income Latino preschool children. ¡Míranos! can be disseminated to various organized childcare settings, as it is built on the Head Start program and its infrastructure, which set a gold standard for early childhood education, as well as current PA and nutrition recommendations for preschool children. TRIAL REGISTRATION ClinicalTrials.Gov ( NCT03590834 ) July 18, 2018.
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Affiliation(s)
- Zenong Yin
- Department of Kinesiology, Health and Nutrition, The University of Texas at San Antonio, San Antonio, TX USA
| | - Sarah L. Ullevig
- Department of Kinesiology, Health and Nutrition, The University of Texas at San Antonio, San Antonio, TX USA
| | - Erica Sosa
- Department of Kinesiology, Health and Nutrition, The University of Texas at San Antonio, San Antonio, TX USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, The University of Maryland, School of Medicine, Baltimore, MD USA
| | - Todd Olmstead
- Department of Mexican American and Latina/o Studies Austin, The University of Texas at Austin, Austin, TX USA
| | - Jeffrey T. Howard
- Department of Kinesiology, Health and Nutrition, The University of Texas at San Antonio, San Antonio, TX USA
| | - Vanessa L. Errisuriz
- Department of Mexican American and Latina/o Studies Austin, The University of Texas at Austin, Austin, TX USA
| | - Vanessa M. Estrada
- Department of Kinesiology, Health and Nutrition, The University of Texas at San Antonio, San Antonio, TX USA
| | - Cristina E. Martinez
- Department of Kinesiology, Health and Nutrition, The University of Texas at San Antonio, San Antonio, TX USA
| | - Meizi He
- Department of Kinesiology, Health and Nutrition, The University of Texas at San Antonio, San Antonio, TX USA
| | - Sharon Small
- Parent/Child Incorporated of San Antonio and Bexar County, San Antonio, TX USA
| | | | - Deborah Parra-Medina
- Department of Mexican American and Latina/o Studies Austin, The University of Texas at Austin, Austin, TX USA
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Korber K, Becker C. Expert opinions on good practice in evaluation of health promotion and primary prevention measures related to children and adolescents in Germany. BMC Public Health 2017; 17:764. [PMID: 28969620 PMCID: PMC5625768 DOI: 10.1186/s12889-017-4773-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Determining what constitutes “good practice” in the measurement of the costs and effects of health promotion and disease prevention measures is of particular importance. The aim of this paper was to gather expert knowledge on (economic) evaluations of health promotion and prevention measures for children and adolescents, especially on the practical importance, the determinants of project success, meaningful parameters for evaluations, and supporting factors, but also on problems in their implementation. This information is targeted at people responsible for the development of primary prevention or health promotion programs. Methods Partially structured open interviews were conducted by two interviewers and transcribed, paraphrased, and summarized for further use. Eight experts took part in the interviews. Results The interviewed experts saw evaluation as a useful tool to establish the effects of prevention programs, to inform program improvement and further development, and to provide arguments to decision making. The respondents’ thought that determinants of a program’s success were effectiveness with evidence of causality, cost benefit relation, target-group reach and sustainability. It was considered important that hard and soft factors were included in an evaluation; costs were mentioned only by one expert. According to the experts, obstacles to evaluation were lacking resources, additional labor requirements, and the evaluators’ unfamiliarity with a program’s contents. It was recommended to consider evaluation design before a program is launched, to co-operate with people involved in a program and to make use of existing structures. Conclusion While in in this study only a partial view of expert knowledge is represented, it could show important points to consider when developing evaluations of prevention programs. By considering these points, researchers could further advance towards a more comprehensive approach of evaluation targeting measures in children and adolescents.
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Affiliation(s)
- Katharina Korber
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, 80539, Munich, Germany. .,Institute for Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, 85764, Neuherberg, Germany.
| | - Christian Becker
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, 85764, Neuherberg, Germany
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Miles TP, Allegra JC, Ezeamama A, Simpson C, Gerst-Emerson K, Elkins J. In a Longevity Society, Loss and Grief Are Emerging Risk Factors for Health Care Use: Findings From the Health and Retirement Survey Cohort Aged 50 to 70 Years. Am J Hosp Palliat Care 2014; 33:41-6. [PMID: 25258335 DOI: 10.1177/1049909114552125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In a society of long lives, parent and child life can overlap by as much as 50 years. Most children now experience the death of their parents as adults. Many of the 2.5 million deaths each year in the United States are parents. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, we estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87%). A report of any loss increases risk of health care utilization by 20% to 30%. For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care.
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Affiliation(s)
- Toni P Miles
- Institute of Gerontology, College of Public Health, University of Georgia, Athens, GA, USA
| | - Joseph C Allegra
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Amara Ezeamama
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | | | - Kerstin Gerst-Emerson
- Institute of Gerontology, College of Public Health, University of Georgia, Athens, GA, USA
| | - Jennifer Elkins
- School of Social Work, University of Georgia, Athens, GA, USA
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John J, Teuner CM. Combating pediatric obesity in Germany: the role of economic findings in informing policy. Expert Rev Pharmacoecon Outcomes Res 2013; 12:733-43. [PMID: 23252356 DOI: 10.1586/erp.12.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As in most countries, overweight and obesity among children and adolescents have dramatically increased in Germany over the last two decades. This serious public-health challenge has stimulated many efforts to curb the pediatric obesity epidemic. In this article, the authors briefly describe these efforts and examine the role of health economics in informing German health policies and evaluating the outcomes of interventions aimed at reducing pediatric obesity. The findings indicate that the tools of health-economic analysis have rarely been used to guide the development of strategies to prevent pediatric obesity and to support decision-making on the use of the scarce resources available for preventive actions. The authors give some reasons why health economics has not been an important policy tool so far and make some recommendations for how this could be changed. Reasons impeding health economics playing a more important role in this area are the existence of many unsolved issues in the methods of health economic evaluation and large gaps in the knowledge base on the effectiveness of interventions. Nevertheless, these methods should be considered to be indispensible tools of health policy development. However, taking into account the broad range of political and societal concerns related to pediatric obesity, decision-making in this area will ultimately rest on a process of deliberate thinking integrating different perspectives among, which health economics will be one.
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Affiliation(s)
- Jürgen John
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstr. 1, D-85764 Neuherberg, Germany.
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Wolfenstetter SB, Schweikert B, John J. Programme costing of a physical activity programme in primary prevention: should the costs of health asset assessment and participatory programme development count? Adv Prev Med 2012; 2012:601631. [PMID: 22536517 PMCID: PMC3318195 DOI: 10.1155/2012/601631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 12/27/2011] [Accepted: 01/09/2012] [Indexed: 11/18/2022] Open
Abstract
This analysis aims to discuss the implications of the "health asset concept", introduced by the WHO, and the "investment for health model" requiring a "participatory approach" of cooperative programme development applied on a physical activity programme for socially disadvantaged women and to demonstrate the related costing issues as well as the relevant decision context. The costs of programme implementation amounted to €48,700. Adding the costs for developing the programme design of €48,800 results in total costs of €97,500; adding on top of that the costs of asset assessment running to €35,600 would total €133,100. These four different cost figures match four different types of potentially relevant decisions contexts. Depending on the decision context the total costs, and hence the incremental cost-effectiveness ratio of a health promotion intervention, could differ considerably. Therefore, a detailed cost assessment and the identification of the decision context are of crucial importance.
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Affiliation(s)
- Silke B. Wolfenstetter
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Land Straße 1, 85764 Neuherberg, Germany
| | - Bernd Schweikert
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Land Straße 1, 85764 Neuherberg, Germany
- Life Sciences, OptumInsight, Munich, Germany
| | - Jürgen John
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Land Straße 1, 85764 Neuherberg, Germany
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