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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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Murphy P, Hinde S, Fulbright H, Padgett L, Richardson G. Methods of assessing value for money of UK-based early childhood public health interventions: a systematic literature review. Br Med Bull 2022; 145:88-109. [PMID: 36542119 PMCID: PMC10075243 DOI: 10.1093/bmb/ldac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Economic evaluation has an important role to play in the demonstration of value for money of early childhood public health interventions; however, concerns have been raised regarding their consistent application and relevance to commissioners. This systematic review of the literature therefore aims to collate the breadth of the existing economic evaluation evidence of these interventions and to identify the approaches adopted in the assessment of value. SOURCE OF DATA Recently published literature in Medline, EMBASE, EconLit, Health Management Information Consortium, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Health Technology Assessment, NHS EED and Web of Science. AREAS OF AGREEMENT The importance of the early childhood period on future health and well-being as well as the potential to impact health inequalities making for a strong narrative case for expenditure in early childhood public health. AREAS OF CONTROVERSY The most appropriate approaches to evaluating value for money of such preventative interventions relevant for UK decision-makers given the evident challenges. GROWING POINTS The presented review considered inconsistencies across methodological approaches used to demonstrate value for money. The results showed a mixed picture in terms of demonstrating value for money. AREAS TIMELY FOR DEVELOPING RESEARCH Future resource allocations decisions regarding early childhood public health interventions may benefit from consistency in the evaluative frameworks and health outcomes captured, as well as consistency in approaches to incorporating non-health costs and outcomes, incorporating equity concerns and the use of appropriate time horizons.
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Affiliation(s)
- Peter Murphy
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Helen Fulbright
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Louise Padgett
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
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3
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Mahdi S, Marr C, Buckland NJ, Chilcott J. Methods for the economic evaluation of obesity prevention dietary interventions in children: A systematic review and critical appraisal of the evidence. Obes Rev 2022; 23:e13457. [PMID: 35478373 PMCID: PMC9542346 DOI: 10.1111/obr.13457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aim to describe and provide a discussion of methods used to conduct economic evaluations of dietary interventions in children and adolescents, including long-term modelling, and to make recommendations to assist health economists in the design and reporting of such evaluations. METHODS A systematic review was conducted in 11 bibliographic databases and the grey literature with searches undertaken between January 2000 and December 2021. A study was included if it (1) was an economic evaluation or modelling study of an obesity-prevention dietary intervention and (2) targeted 2- to 18-year-olds. RESULTS Twenty-six studies met the inclusion criteria. Twelve studies conducted an economic evaluation alongside a clinical trial, and 14 studies modelled long-term health and cost outcomes. Four overarching methodological challenges were identified: modelling long-term impact of interventions, measuring and valuing health outcomes, cost inclusions and equity considerations. CONCLUSIONS Variability in methods used to predict, measure and value long-term benefits in adulthood from short-term clinical outcomes in childhood was evident across studies. Key recommendations to improve the design and analysis of future economic evaluations include the consideration of weight regain and diminishing intervention effects within future projections; exploration of wider intervention benefits not restricted to quality-of-life outcomes; and inclusion of parental or caregiver opportunity costs.
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Affiliation(s)
- Sundus Mahdi
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, UK
| | - Colette Marr
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, UK
| | - Nicola J Buckland
- Department of Psychology, University of Sheffield, Cathedral Court, Sheffield, UK
| | - Jim Chilcott
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, UK
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Tran HNQ, Killedar A, Tan EJ, Moodie M, Hayes A, Swinburn B, Nichols M, Brown V. Cost-effectiveness of scaling up a whole-of-community intervention: The Romp & Chomp early childhood obesity prevention intervention. Pediatr Obes 2022; 17:e12915. [PMID: 35301814 PMCID: PMC9540361 DOI: 10.1111/ijpo.12915] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/20/2022] [Accepted: 03/07/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Given the high prevalence of early childhood overweight and obesity, more evidence is required to better understand the cost-effectiveness of community-wide interventions targeting obesity prevention in children aged 0-5 years. OBJECTIVES To assess the cost-effectiveness of the Romp & Chomp community-wide early childhood obesity prevention intervention if delivered across Australia in 2018 from a funder perspective, against a no-intervention comparator. METHODS Intervention costs were estimated in 2018 Australian dollars. The annual Early Prevention of Obesity in Childhood micro-simulation model estimated body mass index (BMI) trajectories to age 15 years, based on end of trial data at age 3.5 years. Results from modelled cost-effectiveness analyses were presented as incremental cost-effectiveness ratios (ICERs): cost per BMI unit avoided, and cost per quality-adjusted life year (QALY) gained at age 15 years. RESULTS All Australian children aged 0-5 years (n = 1 906 075) would receive the intervention. Total estimated intervention cost and annual cost per participant were AUD178 million and AUD93, respectively, if implemented nationally. The ICERs were AUD1 126 per BMI unit avoided and AUD26 399 per QALY gained (64% probability of being cost-effective measured against a AUD50 000 per QALY threshold). CONCLUSIONS Romp & Chomp has a fair probability of being cost-effective if delivered at scale.
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Affiliation(s)
- Huong Ngoc Quynh Tran
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Anagha Killedar
- Faculty of Medicine and Health, School of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - Eng Joo Tan
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Alison Hayes
- Faculty of Medicine and Health, School of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - Boyd Swinburn
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
- School of Population Health, University of AucklandAucklandNew Zealand
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
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Derwig M, Tiberg I, Björk J, Welander Tärneberg A, Hallström IK. A child-centered health dialogue for the prevention of obesity in child health services in Sweden - A randomized controlled trial including an economic evaluation. Obes Sci Pract 2022; 8:77-90. [PMID: 35127124 PMCID: PMC8804939 DOI: 10.1002/osp4.547] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Prevention of child obesity is an international public health priority and believed to be effective when started in early childhood. Caregivers often ask for an early and structured response from health professionals when their child is identified with overweight, yet cost-effective interventions for children aged 2-6 years and their caregivers in Child Health Services are lacking. OBJECTIVES To evaluate the effects and cost-effectiveness of a child-centered health dialogue in the Child Health Services in Sweden on 4-year-old children with normal weight and overweight. METHODS Thirty-seven Child Health Centers were randomly assigned to deliver intervention or usual care. The primary outcome was zBMI-change. RESULTS A total of 4598 children with normal weight (zBMI: 0.1 [SD = 0.6] and 490 children with overweight (zBMI: 1.6 [SD = 0.3]) (mean age: 4.1 years [SD = 0.1]; 49% females) were included. At follow-up, at a mean age of 5.1 years [SD = 0.1], there was no intervention effect on zBMI-change for children with normal weight. Children with overweight in the control group increased zBMI by 0.01 ± 0.50, while children in the intervention group decreased zBMI by 0.08 ± 0.52. The intervention effect on zBMI-change for children with overweight was -0.11, with a 95% confidence interval of -0.24 to 0.01 (p = 0.07). The estimated additional costs of the Child-Centered Health Dialogue for children with overweight were 167 euros per child with overweight and the incremental cost-effectiveness ratio was 183 euros per 0.1 zBMI unit prevented. CONCLUSIONS This low-intensive multicomponent child-centered intervention for the primary prevention of child obesity did not show statistical significant effects on zBMI, but is suggested to be cost-effective with the potential to be implemented universally in the Child Health Services. Future studies should investigate the impact of socio-economic factors in universally implemented obesity prevention programs.
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Affiliation(s)
- Mariette Derwig
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Irén Tiberg
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Jonas Björk
- Department of Laboratory MedicineLund UniversityLundSweden
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Seleznova Y, Alayli A, Stock S, Müller D. Methodological issues in economic evaluations of disease prevention and health promotion: an overview of systematic and scoping reviews. BMC Public Health 2021; 21:2130. [PMID: 34801013 PMCID: PMC8605499 DOI: 10.1186/s12889-021-12174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to provide a comprehensive overview of methodological challenges in economic evaluations of disease prevention and health promotion (DPHP)-measures. Methods We conducted an overview of reviews searching MEDLINE, EMBASE, NHS Economic Evaluation Database, Database of Promoting Health Effectiveness Reviews, Cochrane Database of Systematic Reviews (CDSR) and Database of Promoting Health Effectiveness Reviews (DOPHER) (from their inception to October 2021). We included both systematic and scoping reviews of economic evaluations in DPHP addressing following methodological aspects: (i) attribution of effects, (ii) outcomes, (iii) inter-sectoral (accruing to non-health sectors of society) costs and consequences and (iv) equity. Data were extracted according to the associated sub-criteria of the four methodological aspects including study design economic evaluation (e.g. model-based), type/scope of the outcomes (e.g. outcomes beyond health), perspective, cost categories related to non-health sectors of society, and consideration of equity (method of inclusion). Two reviewers independently screened all citations, full-text articles, and extracted data. A narrative synthesis without a meta-analysis or other statistical synthesis methods was conducted. Results The reviewing process resulted in ten systematic and one scoping review summarizing 494 health economic evaluations. A lifelong time horizon was adopted in about 23% of DPHP evaluations, while 64% of trial-based evaluations had a time horizon up to 2 years. Preference-based outcomes (36%) and non-health outcomes (8%) were only applied in a minority of studies. Although the inclusion of inter-sectoral costs (i.e. costs accruing to non-health sectors of society) has increased in recent years, these were often neglected (between 6 and 23% depending on the cost category). Consideration to equity was barely given in economic evaluations, and only addressed in six of the eleven reviews. Conclusions Economic evaluations of DPHP measures give only little attention to the specific methodological challenges related to this area. For future economic DPHP evaluations a tool with structured guidance should be developed. This overview of reviews was not registered and a published protocol does not exist. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12174-w.
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Affiliation(s)
- Yana Seleznova
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany.
| | - Adrienne Alayli
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
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7
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Robatsch J, Voitl P, Diesner-Treiber SC. A cross-sectional, exploratory survey on health-relevant free-time activities and body mass index in preschool children in urban and rural settings of Austria. BMC Pediatr 2021; 21:495. [PMID: 34742276 PMCID: PMC8571826 DOI: 10.1186/s12887-021-02972-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The increasing prevalence of obesity is among the most relevant healthcare issues in Europe. The number of overweight people rises due to lifestyle changes, increased sitting activities, and less physical activity. Prevention in early childhood is paramount to stop this alarming trend. AIM This study primarily aimed to evaluate the average time children (3-5 years) from rural and urban Austrian regions spent engaging in physical activity and sedentary behaviors in their free-time. Additionally, we investigated the potential correlation between duration and habits of free-time activity or place of residence and age- and sex-specific body mass index (BMI). The potential impact of socio-economic factors on BMI was examined. METHODS Urban (Vienna) and rural (Carinthia) regions of Austria were chosen for this observational cross-sectional study. Preschool children (n=130) attending nurseries in these regions were included. Weight and height were measured and BMI calculated. Free-time activity and socio-economic data were asked using a self-administered questionnaire. Data on sedentary behavior time (sedentary activity and media consumption) and physical activity time (defined as organized or spontaneous exercise) were analyzed using non-parametric tests. RESULTS Preschool children spent approximately as many hours of their free-time engaged in physical activity as in sedentary behaviors. Time trend in media consumption amounts to one-third of the cumulative time spent engaging in sedentary behaviors. Preschoolers from the urban area spent fewer hours practicing organized exercise and more in sedentary behaviors than peers in the rural area. In the selected areas, 7 % of preschoolers were overweight, 3.9 % were obese. BMI was not associated with free-time activities but showed a trendwise negative correlation with organized exercise. A positive correlation of age and organized exercise was observed but not with physical activity per se. CONCLUSIONS Our results confirm the necessity of preventive interventions among Austrian preschoolers and lead to a better understanding of their free-time activities. Further investigations with larger study populations are needed to promote effective childhood obesity prevention and examine the differences regarding obesity prevalence and leisure-time activity between rural and urban areas.
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Affiliation(s)
- J. Robatsch
- First Vienna Pediatric Medical Center, Donau-City Strasse 1, 1220 Vienna, Austria
| | - P. Voitl
- First Vienna Pediatric Medical Center, Donau-City Strasse 1, 1220 Vienna, Austria
- Sigmund Freud University Vienna, Donau-City Strasse 1, 1220 Vienna, Austria
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Hale I, Jackson E. Evaluating routine pediatric growth measurement as a screening tool for overweight and obese status. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:161-165. [PMID: 33727374 DOI: 10.46747/cfp.6703161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ilona Hale
- Family physician and Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia.
| | - Emma Jackson
- Family medicine resident at the University of British Columbia
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9
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Hale I, Jackson E. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:166-170. [PMID: 33727375 PMCID: PMC7963017 DOI: 10.46747/cfp.6703166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ilona Hale
- Médecin de famille et professeure adjointe de clinique au Département de la pratique familiale de l'Université de la Colombie-Britannique.
| | - Emma Jackson
- Résidente en médecine familiale à l'Université de la Colombie-Britannique
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10
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Reeves P, Edmunds K, Szewczyk Z, Grady A, Yoong SL, Wolfenden L, Wyse R, Finch M, Stacey F, Wiggers J, Searles A. Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines. Implement Sci 2021; 16:1. [PMID: 33413491 PMCID: PMC7789335 DOI: 10.1186/s13012-020-01068-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
Background Despite the known benefits of healthy eating in childhood, few Australian childcare services provide food that is consistent with dietary guidelines. The effectiveness of a web-based menu planning intervention to increase childcare service provision of healthy foods and decrease provision of discretionary foods in long day-care services in Australia was assessed in a randomised controlled trial. Here we consider the costs, consequences, cost-effectiveness and budget impact of the intervention using data collected within the trial. Methods The prospective trial-based economic evaluation involved 54 childcare services across New South Wales (NSW), Australia. Services were randomised to a 12-month intervention or usual care. The intervention involved access to a web-based menu planning and decision support tool and online resources. Effectiveness measures included mean number of food groups, overall menu and individual food group compliance with dietary guidelines, and mean servings of food groups at 12 months. Costs (reported in $AUD, 2017/18) were evaluated from both health sector and societal perspectives. The direct cost to support uptake of the intervention was calculated, as were costs to each childcare service. The incremental cost of the intervention was calculated as the net difference in the cost to undertake menu planning and review plus the direct cost of the intervention. Incremental cost-effectiveness ratios (ICERs) including uncertainty intervals were estimated for differences in costs and effects between intervention and control groups. A relative value index was calculated to determine overall value for money. Results Over the 12 months of the trial, we calculated a difference in cost between usual practice and intervention groups of − $482 (95% UI − $859, − $56). While the measured increase in menu and food group compliance within the trial did not reach statistical significance, there were significant improvements in mean servings of fruit and discretionary food, represented in the cost-consequence analysis. The calculated relative value index of 1.1 suggests that the intervention returns acceptable value for money for the outcomes generated. Conclusion Compared to usual practice, web-based programmes may offer an efficient and sustainable alternative for childcare services to improve the provision of healthy foods to children in their care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12616000974404
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Affiliation(s)
- Penny Reeves
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia. .,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.
| | - Kim Edmunds
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Zoe Szewczyk
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Alice Grady
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Sze Lin Yoong
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Wyse
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Meghan Finch
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Fiona Stacey
- Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia
| | - John Wiggers
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Searles
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
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11
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Brown V, Tan EJ, Hayes A, Baur L, Campbell K, Taylor R, Byrne R, Wen LM, Hesketh KD, Moodie M. Cost comparison of five Australasian obesity prevention interventions for children aged from birth to two years. Pediatr Obes 2020; 15:e12684. [PMID: 32558343 DOI: 10.1111/ijpo.12684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the absence of rigorous evidence of cost-effectiveness for early childhood obesity prevention interventions, the next-best option may be for decision-makers to consider the relevant costs of interventions when allocating resources. OBJECTIVES This study aimed to estimate systematically the cost of five obesity prevention interventions in children aged 0-2 years, undertaken in research settings in Australia and New Zealand. METHODS A standardised costing protocol informed the costing methodology, ensuring comparability of results across interventions. Micro-costing was undertaken, with intervention costs defined from the funder perspective and valued in 2018 Australian dollars using unit costs from the trials or market rates. RESULTS Interventions varied widely in their resource use. The total cost per participant ranged from $80 for the CHAT SMS intervention arm (95% UI $77-$82) to $1135 for the Healthy Beginnings intervention (95% UI $1059-$1189). Time costs of personnel delivering interventions contributed >50% of total intervention costs for all included studies. CONCLUSIONS An understanding of the costs associated with intervention delivery modes is important, alongside effectiveness. Telephone delivery may include unexpected costs associated with connection to intervention participants at convenient times. A SMS-based intervention had the lowest delivery cost in this study.
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Affiliation(s)
- Vicki Brown
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Eng J Tan
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Baur
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Campbell
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rachael Taylor
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Rebecca Byrne
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,School of Exercise and Nutrition Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Li Ming Wen
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kylie D Hesketh
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Marjory Moodie
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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12
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Tan EJ, Taylor RW, Taylor BJ, Brown V, Hayes AJ. Cost-Effectiveness of a Novel Sleep Intervention in Infancy to Prevent Overweight in Childhood. Obesity (Silver Spring) 2020; 28:2201-2208. [PMID: 33012118 DOI: 10.1002/oby.22989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to determine, from a health funder perspective, whether a sleep intervention, delivered in infancy, either alone or in combination with food, activity, and breastfeeding advice was cost-effective compared with usual care. METHODS A cost-effectiveness analysis was conducted alongside the Prevention of Overweight in Infancy (POI) randomized controlled trial for outcomes at 5 years and cost-effectiveness was modeled to age 15 years using the Early Prevention of Obesity in Childhood microsimulation model. Intervention costs for the Sleep (n = 192), Combination (n = 196), and control (n = 209) groups were determined in 2018 Australian dollars. Incremental cost-effectiveness ratios (ICERs) were determined for BMI outcomes at 5 and 15 years, with the primary outcome being quality-adjusted life years (QALYs) modeled over 15 years. RESULTS The average costs of the Sleep and Combination interventions were $184 and $601 per child, respectively. The ICER for the Sleep intervention was $18,125 per QALY gained, with a 74% probability of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY. The ICER for the Combination intervention was $94,667 per QALY gained with a 23% probability of being cost-effective. CONCLUSIONS The POI Sleep intervention, without additional advice, was a low-cost and cost-effective approach to reducing childhood obesity. Sleep modification programs offer a very promising approach to obesity prevention in children.
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Affiliation(s)
- Eng Joo Tan
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry J Taylor
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Alison J Hayes
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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13
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Lauer R, Traub M, Hansen S, Kilian R, Steinacker JM, Kesztyüs D. Longitudinal changes and determinants of parental willingness to pay for the prevention of childhood overweight and obesity. HEALTH ECONOMICS REVIEW 2020; 10:15. [PMID: 32468490 PMCID: PMC7257510 DOI: 10.1186/s13561-020-00266-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Willingness to Pay (WTP) is an alternative to measure quality-adjusted life years for cost-effectiveness analyses. The aim was to evaluate longitudinal changes and determinants of parental WTP for the prevention of childhood overweight and obesity. METHODS Longitudinal data from post- (T2) and follow-up (T3) measurements of a school-based health promotion program in Germany. Parental questionnaires included general WTP and the corresponding amount to reduce incidental childhood overweight and obesity by half. Longitudinal differences were examined with the McNemar test for general WTP and the Wilcoxon signed-rank test for the amount of WTP. Regression analyses were conducted to detect determinants. RESULTS General parental WTP significantly decreased from 48.9% to 35.8% (p < 0.001, n = 760). Logistic regression analysis (n = 561) showed that parents with a tertiary education level and a positive general WTP at T2, families with a higher monthly household income, and those with abdominally obese children were significant predictors of general WTP at T3. Median amount of WTP at T3 was €20.00 (mean = €27.96 ± 26.90, n = 274). Assuming a WTP of €0 for those who were generally not willing to pay or did not answer, resulted in a median amount of WTP at T3 of €0 (m = €8.45, sd = €19.58, n = 906). According to linear regression analysis WTP at T2 was the only significant predictor for the amount of WTP at T3 (p = 0.000, n = 181). CONCLUSIONS Despite the decline of general WTP, these results are a reflection of the public awareness of the problem and the need for action. Policy makers should recognize this and initiate sustainable public preventive strategies. TRIAL REGISTRATION DRKS, DRKS00000494. Registered 25 August 2010, https://www.drks.de/drks_web/.
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Affiliation(s)
- Romy Lauer
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Meike Traub
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
- Department of University Sports / Workplace Health Management, Ulm University, Ulm, Germany
| | - Sylvia Hansen
- Ceres - Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, Unversity of Cologne, Cologne, Germany
| | - Reinhold Kilian
- Section Health Economics and Health Services Research, Department of Psychiatry II, Ulm University Medical Center, Günzburg, Germany
| | | | - Dorothea Kesztyüs
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
- Institute of General Practice, Ulm University Medical Center, Ulm, Germany
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14
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Killedar A, Lung T, Petrou S, Teixeira-Pinto A, Hayes A. Estimating Age- and Sex-Specific Utility Values from the CHU9D Associated with Child and Adolescent BMI z-Score. PHARMACOECONOMICS 2020; 38:375-384. [PMID: 31814078 DOI: 10.1007/s40273-019-00866-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Our objective was to identify age- and sex-specific utilities for children and adolescents by body mass index (BMI) z-score. METHODS We used data from 6822 participants and 12,094 observations from two cohorts and two waves of interviews from the Longitudinal Study of Australian Children. We fit linear models using generalised estimating equations to investigate associations between Child Health Utility 9D and BMI z-score in girls and boys aged 10-17 years. We initially fit models for each sex, fully adjusted for known predictors of health-related quality of life, including socioeconomic position, long-term medical condition and maternal smoking status and also included an interaction between age and BMI z-score to examine age-specific effects. Finally, we derived a minimal model for each sex by eliminating interaction terms with P > 0.01 and predictors with P > 0.05. RESULTS Our adjusted results show different utility patterns in girls and boys. In girls, utility decrements for each unit increase in BMI z-score changed with age (P < 0.01 for interaction between age and BMI z-score). At age 10 years, the mean utility decrement for each unit increase in BMI z-score was 0.002 (95% confidence interval [CI] 0.011 decrement to 0.006 increment), but, by age 17 years, this utility decrement was 0.023 (95% CI 0.013 to 0.032). In boys, small non-significant decrements were found in utility for each unit increase in BMI z-score, with no observable change with age. CONCLUSION Our analyses demonstrated that age and sex should be considered when attributing utility values and decrements to BMI z-scores.
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Affiliation(s)
- Anagha Killedar
- Faculty of Medicine and Health, School of Public Health, Edward Ford Building A27, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Thomas Lung
- Faculty of Medicine and Health, School of Public Health, Edward Ford Building A27, University of Sydney, Sydney, NSW, 2006, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Armando Teixeira-Pinto
- Faculty of Medicine and Health, School of Public Health, Edward Ford Building A27, University of Sydney, Sydney, NSW, 2006, Australia
| | - Alison Hayes
- Faculty of Medicine and Health, School of Public Health, Edward Ford Building A27, University of Sydney, Sydney, NSW, 2006, Australia
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15
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Guguen C, Launois C, Dormoy V, Dewolf M, Dumazet A, Dury S, Lebargy F, Deslee G, Perotin JM. [Obesity and asthma: Mechanisms and therapeutic options]. Rev Mal Respir 2019; 37:134-143. [PMID: 31864881 DOI: 10.1016/j.rmr.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/22/2022]
Abstract
Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.
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Affiliation(s)
- C Guguen
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - C Launois
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - V Dormoy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - M Dewolf
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - A Dumazet
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - S Dury
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - F Lebargy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - G Deslee
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - J-M Perotin
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
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16
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Hennessy M, Heary C, Laws R, van Rhoon L, Toomey E, Wolstenholme H, Byrne M. The effectiveness of health professional-delivered interventions during the first 1000 days to prevent overweight/obesity in children: A systematic review. Obes Rev 2019; 20:1691-1707. [PMID: 31478333 DOI: 10.1111/obr.12924] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/22/2022]
Abstract
Childhood obesity is a global public health challenge. Early prevention, particularly during the first 1000 days, is advocated. Health professionals have a role to play in obesity prevention efforts, in part due to the multiple routine contacts they have with parents. We synthesized the evidence for the effectiveness of obesity prevention interventions delivered by health professionals during this time period, as reviews to date have not examined effectiveness by intervention provider. We also explored what behaviour change theories and/or techniques were associated with more effective intervention outcomes. Eleven electronic databases and three trial registers were searched from inception to 04 April 2019. A total of 180 studies, describing 39 trials involving 46 intervention arms, were included. While the number of interventions has grown considerably, we found some evidence for the effectiveness of health professional-delivered interventions during the first 1000 days. Only four interventions were effective on a primary (adiposity/weight) and secondary (behavioural) outcome measure. Twenty-two were effective on a behavioural outcome only. Several methodological limitations were noted, impacting on efforts to establish the active ingredients of interventions. Future work should focus on the conduct and reporting of interventions.
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Affiliation(s)
- Marita Hennessy
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Luke van Rhoon
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Hazel Wolstenholme
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
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17
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Shape Up Somerville's return on investment: Multi-group exposure generates net-benefits in a child obesity intervention. Prev Med Rep 2019; 16:100954. [PMID: 31463186 PMCID: PMC6706678 DOI: 10.1016/j.pmedr.2019.100954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 01/02/2023] Open
Abstract
Community-based interventions may reduce and prevent childhood obesity by transforming the environments in which children live, learn, and play through a series of interventions implemented throughout the community that encourage healthy behaviors. While empirical support is building for the effectiveness of such interventions, little is known about the economic costs and benefits of community-wide childhood obesity interventions. This study examined whether the benefits of a community-wide, child-focused, obesity prevention intervention, Shape Up Somerville: Eat Smart Play Hard (SUS), exceeded its costs by estimating its return on investment. The SUS intervention study occurred in Somerville, Massachusetts (and in two additional geographic areas, which were the study's control group) during the 2003/04 and 2004/05 school years. We estimated SUS's costs using SUS data over the two-year intervention. We estimated benefits (i.e., healthcare costs and productivity losses averted for children and their parents) over a ten-year time horizon using SUS effectiveness results and other sources. SUS generated an estimated $1.51 in savings for every $1.00 invested in the program (return on investment of $0.51). Over ten years, the estimated costs averted were over $500,000 with net benefits of $197,120 (2014 dollars). SUS was estimated to be a cost-saving intervention when examined over a ten-year time horizon. The excess benefits generated by SUS likely arose from the community-wide nature of the intervention which extended exposure (and estimated benefits) beyond children to parents as well. These results illustrate that allocating resources to community-wide, child-focused obesity prevention interventions may be a beneficial investment.
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18
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Brown V, Ananthapavan J, Sonntag D, Tan EJ, Hayes A, Moodie M. The potential for long-term cost-effectiveness of obesity prevention interventions in the early years of life. Pediatr Obes 2019; 14:e12517. [PMID: 30816024 DOI: 10.1111/ijpo.12517] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early childhood obesity prevention is gaining increasing importance, as the prevalence of children with overweight and obesity aged 5 years and under increases worldwide. Along with understanding the effectiveness of obesity interventions, it is important to understand the cost-effectiveness of interventions over time. OBJECTIVES To estimate the long-term health benefits and health care cost-savings of reductions in BMI for the Australian population of children aged between 2 and 5 years. METHODS A proportional multistate, multiple cohort lifetable model estimated the health benefits and health care cost-savings related to hypothetical reductions in BMI, informed by a scoping review of systematic reviews reporting the effectiveness of obesity prevention interventions in preschool aged children. RESULTS Results suggest significant potential for cost-effectiveness of obesity prevention interventions in preschool-aged children if intervention effect can be maintained. A relatively small population level reduction in BMI z-score (-0.13 BMIz) in children aged 2 to 5 years would result in 36 496 health-adjusted life years saved (95% uncertainty interval [UI], 30 283-42 945) and health care cost-savings of approximately $301 million (95% UI $234 million-$369 million) if modelled over the lifetime. CONCLUSIONS Scenario results highlight the importance of obesity intervention in the early years of life.
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Affiliation(s)
- Vicki Brown
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty of the Heidelberg University, Mannheim, Germany.,Department of Health Sciences, University of York, York, UK
| | - Eng Joo Tan
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marj Moodie
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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19
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Salwa M, Atiqul Haque M, Khalequzzaman M, Al Mamun MA, Bhuiyan MR, Choudhury SR. Towards reducing behavioral risk factors of non-communicable diseases among adolescents: protocol for a school-based health education program in Bangladesh. BMC Public Health 2019; 19:1002. [PMID: 31345186 PMCID: PMC6659286 DOI: 10.1186/s12889-019-7229-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Developing strategies aimed at reducing behavioral risk factors and hence the prevalence of non-communicable diseases (NCDs) is a major challenge to the policy makers today. Like the same age group worldwide, the prevalence of obesity, unhealthy dietary habit, physical inactivity, smoking and alcohol intake is high among the adolescents of Bangladesh. Studies showed promising results of an early intervention at adolescent age in reducing the likelihood of NCDs at adult age. So, this study is designed to implement a behavior change intervention and evaluate the effectiveness of the intervention in reducing the behavioral risk factors of NCDs among the adolescents of Bangladesh. METHODS A before-after designed intervention study will be conducted in two randomly selected secondary schools- one will be selected randomly as intervention school and the another as control school. A baseline survey will be conducted among the students of both schools by a pre-tested questionnaire to attain their current status of knowledge, attitude and practices related to NCDs. Afterward, students will be enrolled in the intervention group who will meet the eligibility criteria from the intervention school. The intervention will be given through a health promotion session to a group of students, not more than 25 at a time, by trained facilitators. A post-intervention end line survey will be conducted among all the participants from both schools using the same questionnaire 3 months after the baseline survey. DISCUSSION An intervention has been developed based on some principals of two psychosocial theory- Motivational Interview and Social Cognitive Theory. Emphasis will be given on motivating the adolescents towards a healthy lifestyle, supporting self-efficacy to be changed, guiding self-regulatory ways along with facilitating desired changing process by empowering them with choices about the preventive measures of NCDs. This intervention is expected to increase awareness by equipping the adolescents with specific knowledge and skills and thus, facilitate an eventual change in their practiced risk behaviors. Besides, this intervention will address multiple behaviors at a time, and will be delivered to a group of adolescents, to attain the cost-effectiveness and thereby making it more realistic in the resource-poor context of Bangladesh. TRIAL REGISTRATION ClinicalTrials.gov NCT03975335, registered on 01.06.2019. Retrospectively registered.
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Affiliation(s)
| | - Md Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mohammad Abdullah Al Mamun
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Mahfuzur Rahman Bhuiyan
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
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20
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Assessing the Lifetime Cost-Effectiveness of Low-Protein Infant Formula as Early Obesity Prevention Strategy: The CHOP Randomized Trial. Nutrients 2019; 11:nu11071653. [PMID: 31331027 PMCID: PMC6682975 DOI: 10.3390/nu11071653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/25/2023] Open
Abstract
Background: Although there is a growing number of early childhood obesity prevention programs, only a few of them are effective in the long run. Even fewer reports exist on lifetime cost-effectiveness of early prevention strategies. This paper aimed to assess the lifetime cost-effectiveness of infant feeding modification aiming at reducing risk of later obesity. Methods: The simulation model consists of two parts: (a) Model I used data from the European Childhood Obesity Project (CHOP) trial (up to 6 years) and the German Interview and Examination Survey for Children (KiGGS) (6–17 years) to evaluate BMI trajectories of infants receiving either lower protein (LP) or higher protein (HP) content formula; and (b) Model II estimated lifetime cost-effectiveness based on Model I BMI trajectories. Compared to HP formula, LP formula feeding would incur lower costs that are attributable to childhood obesity across all decades of life. Results: Our analysis showed that LP formula would be cost-effective in terms of a positive net monetary benefit (discounted 3%) as an obesity prevention strategy. For the 19% of infants fed with formula in Germany, the LP strategy would result in cost savings of € 2.5 billion. Conclusions: Our study is one of the first efforts to provide much-needed cost-effectiveness evidence of infant feeding modification, thereby potentially motivating interventionists to reassess their resource allocation.
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21
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Sun K, Xie Y, Zhao N, Li Z. A case-control study of the relationship between visceral fat and development of uterine fibroids. Exp Ther Med 2019; 18:404-410. [PMID: 31258679 PMCID: PMC6566109 DOI: 10.3892/etm.2019.7575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022] Open
Abstract
Relationship between visceral fat and development of uterine fibroids in adult women was investigated. A total of 89 patients with uterine fibroids treated in the First Hospital of Hebei Medical University from April 2016 to April 2018 were enrolled. Another 81 healthy women without uterine fibroids receiving physical examination in the same period were selected as the control group. Self-designed questionnaires were used to investigate the general conditions of the subjects, bioelectrical impedance analysis was employed to analyze obesity-related indicators, and their correlation with the risk of uterine fibroids was explored. Visceral fat area (VFA), body mass index (BMI), body fat percentage, waist circumference, waist-height ratio and waist-hip ratio were positively correlated with the incidence rate of uterine fibroids, and the odds ratio (OR), 95% confidence interval (CI) was 3.910 (2.029, 7.536), 2.716 (1.444, 5.110), 4.335 (1.507, 12.469), 2.881 (1.531, 5.423), 3.837 (1.914, 7.692) and 7.707 (3.501, 16.965), respectively. VFA and body fat percentage were correlated with the size of uterine fibroids, but the correlations were relatively weak. With the increase in the VFA, BMI, waist circumference, waist-height ratio, and waist-hip ratio, the risk of uterine fibroids was elevated. The BMI, VFA and waist circumference of patients with uterine fibroids were gradually increased with increasing age, showing statistically significant differences. Increased body fat (especially abdominal visceral fat) is able to enhance the risk of uterine fibroids. For perimenopausal women, the waist-hip ratio measured can be used as an indicator screening high-risk groups of uterine fibroids. This method is simple, easy and inexpensive. At the same time, providing nutrition guidance and changing diet and exercise habits are important measures to prevent the development of uterine fibroids.
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Affiliation(s)
- Kejuan Sun
- Department of Nursing, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
| | - Ying Xie
- Department of Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
| | - Na Zhao
- Department of Gynecology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
| | - Zengning Li
- Department of Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
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Zanganeh M, Adab P, Li B, Frew E. A Systematic Review of Methods, Study Quality, and Results of Economic Evaluation for Childhood and Adolescent Obesity Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030485. [PMID: 30743995 PMCID: PMC6388206 DOI: 10.3390/ijerph16030485] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/24/2019] [Accepted: 02/03/2019] [Indexed: 12/20/2022]
Abstract
Many suggested policy interventions for childhood and adolescent obesity have costs and effects that fall outside the health care sector. These cross-sectorial costs and consequences have implications for how economic evaluation is applied and although previous systematic reviews have provided a summary of cost-effectiveness, very few have conducted a review of methods applied. We undertook this comprehensive review of economic evaluations, appraising the methods used, assessing the quality of the economic evaluations, and summarising cost-effectiveness. Nine electronic databases were searched for full-economic evaluation studies published between January 2001 and April 2017 with no language or country restrictions. 39 economic evaluation studies were reviewed and quality assessed. Almost all the studies were from Western countries and methods were found to vary by country, setting and type of intervention. The majority, particularly "behavioural and policy" preventive interventions, were cost-effective, even cost-saving. Only four interventions were not cost effective. This systematic review suggests that economic evaluation of obesity interventions is an expanding area of research. However, methodological heterogeneity makes evidence synthesis challenging. Whilst upstream interventions show promise, an expanded and consistent approach to evaluate cost-effectiveness is needed to capture health and non-health costs and consequences.
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Affiliation(s)
- Mandana Zanganeh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Peymane Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Bai Li
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Emma Frew
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
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Hayes A, Tan EJ, Lung T, Brown V, Moodie M, Baur L. A New Model for Evaluation of Interventions to Prevent Obesity in Early Childhood. Front Endocrinol (Lausanne) 2019; 10:132. [PMID: 30881347 PMCID: PMC6405882 DOI: 10.3389/fendo.2019.00132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 02/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background: Childhood obesity is a serious public health issue. In Australia, 1 in 4 children is already affected by overweight or obesity at the time of school entry. Governments around the world have recognized this problem through investment in the prevention of pediatric obesity, yet few interventions in early childhood have been subjected to economic evaluation. Information on cost-effectiveness is vital to decisions about program implementation. A challenge in evaluating preventive interventions in early childhood is to capture long-term costs and outcomes beyond the duration of an intervention, as the benefits of early obesity prevention will not be realized until some years into the future. However, decisions need to be made in the present, and modeling is one way to inform such decisions. Objective: To describe the conceptual structure of a new health economic model (the Early Prevention of Obesity in CHildhood (EPOCH) model) for evaluating childhood obesity interventions; and to validate the epidemiologic predictions. Methods and Results: We use an individual-level (micro-simulation) method to model BMI trajectories and the progression of obesity from early childhood to adolescence. The equations predicting individual BMI change underpinning our model were derived from data from the population-representative study, the Longitudinal Study of Australian Children (LSAC). Our approach is novel because it will account for costs and benefits accrued throughout childhood and adolescence. As a first step to validate the epidemiological predictions of the model, we used input data representing over 250,000 children aged 4/5 years, and simulated BMI and obesity trajectories until adolescence. Simulated mean BMI and obesity prevalence for boys and girls were verified by nationally-representative data on children at 14/15 years of age. Discussion: The EPOCH model is epidemiologically sound in its prediction of both BMI trajectories and prevalence of obesity for boys and girls. Future developments of the model will include socio-economic position and will incorporate the impacts of obesity on healthcare costs. The EPOCH model will help answer: when is it best to intervene in childhood; what are the most cost-effective approaches and which population groups will benefit most from interventions.
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Affiliation(s)
- Alison Hayes
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, Australia
| | - Eng J Tan
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, Australia
| | - Thomas Lung
- Health Economics and Process Evaluation, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Vicki Brown
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Marj Moodie
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Louise Baur
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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Oosterhoff M, Bosma H, van Schayck OCP, Evers SMAA, Dirksen CD, Joore MA. A systematic review on economic evaluations of school-based lifestyle interventions targeting weight-related behaviours among 4-12 year olds: Issues and ways forward. Prev Med 2018; 114:115-122. [PMID: 29959951 DOI: 10.1016/j.ypmed.2018.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 12/12/2022]
Abstract
Current guidelines for economic evaluations do not provide specific recommendations for the evaluation of school-based lifestyle interventions. This study examined and discussed the key aspects in the design of economic evaluations on school-based interventions targeting weight-related behaviours among 4-12 year olds. The PubMed and CRD databases (NHS EED) were searched. Grey literature was identified from reference lists and websites of relevant organizations. Full economic evaluations on school-based interventions targeting physical activity, sedentariness, or diet were selected. Key aspects included the objective, audience, intervention, comparator, population, type of analysis, perspective, costs, outcomes, and time horizon. Information was also extracted on measuring and valuing costs and outcomes, linking and extrapolating outcomes, and the maintenance of intervention effects. The 23 included studies reported on cost-effectiveness (CEAs) (N = 12), cost-utility (CUAs) (N = 9), social cost benefit (SCBA) (N = 2), and social return on investment (SROI) (N = 1) analysis. The usual practice comparator was generally not clearly defined. The SROI analysis was the single study that included outcomes in other persons than the child. Healthcare costs (N = 14), productivity costs (N = 4), and costs to the household (N = 3), or education (N = 2) sector were examined. The outcome in trial-based CEAs consisted of a variety of weight-related measures. Seven distinctive models were used to extrapolate health and/or productivity costs. To enhance the usefulness of economic evaluations on school-based lifestyle interventions in allocating public health budgets, transparent reporting on key aspects, broadening the scope of economic evaluations, and standardizing the measurement, valuation, and extrapolation of costs and outcomes should be improved. This study was conducted in Maastricht, the Netherlands.
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Social Medicine, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Family Medicine, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Health Services Research, P.O. Box 616, 6200, MD, Maastricht, the Netherlands; Trimbos, Netherlands Institute of Mental Health and Addiction, Trimbos, P.O. Box 725, 3500, AS, Utrecht, the Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands
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Gifford JA, Gwynn JD, Hardy LL, Turner N, Henderson LC, Innes-Hughes C, Flood VM. Review of Short-Form Questions for the Evaluation of a Diet, Physical Activity, and Sedentary Behaviour Intervention in a Community Program Targeting Vulnerable Australian Children. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E95. [PMID: 30011873 PMCID: PMC6069381 DOI: 10.3390/children5070095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 01/06/2023]
Abstract
Childhood obesity is associated with low socioeconomic status in developed countries, and community programs can deliver cost-effective obesity interventions to vulnerable children and adolescents at scale. Evaluating these programs in a low-cost, time-efficient, and culturally appropriate way with valid and reliable measures is essential to determining their effectiveness. We aimed to identify existing valid and reliable short-form instruments (≤50 items for diet, ≤15 items for physical activity) suitable for the assessment of change in diet, physical activity, and sedentary behaviour in an Australian obesity intervention program for children and adolescents aged 7⁻13 years from low socioeconomic groups, with a focus on Aboriginal and Torres Strait Islander children. Relevant electronic databases were searched, with a focus on Australian literature. Validity and/or reliability studies using diet instruments (5), physical activity/sedentary behaviour instruments (12), and diet and physical activity/sedentary behaviour instruments used with Aboriginal and Torres Strait Islander (3) children were identified. Seven questions on diet, one question on physical activity, and no questions on sedentary behaviour were recommended. These questions can be used for evaluation in community-based obesity programs among Australian children and adolescents, including those from low socioeconomic groups and Aboriginal and Torres Strait Islander children.
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Affiliation(s)
- Janelle A Gifford
- Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, NSW 2141, Australia.
| | - Josephine D Gwynn
- Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, NSW 2141, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2005, Australia.
| | - Louise L Hardy
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Nicole Turner
- Centre for Rural and Remote Mental Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
- Hunter New England Local Health District, Locked Bag 1, New Lambton, NSW 2305, Australia.
| | - Lily C Henderson
- NSW Office of Preventive Health, Liverpool, NSW 1871, Australia.
| | | | - Victoria M Flood
- Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, NSW 2141, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2005, Australia.
- Western Sydney Local Health District, Westmead, NSW 2145, Australia.
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Tan EJ, Brown V, Petrou S, D'Souza M, Moodie ML, Wen LM, Baur LA, Rissel C, Hayes AJ. Is there an association between early weight status and utility-based health-related quality of life in young children? Qual Life Res 2018; 27:2851-2858. [PMID: 29992501 DOI: 10.1007/s11136-018-1932-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Few studies focus on the health-related quality of life (HRQoL) of preschool children with overweight or obesity. This is relevant for evaluation of obesity prevention trials using a quality-adjusted life year (QALY) framework. This study examined the association between weight status in the preschool years and HRQoL at age 5 years, using a preference-based instrument. METHODS HRQoL [based on parent proxy version of the Health Utilities Index Mark 3 (HUI3)] and weight status were measured in children born in Australia between 2007 and 2009. Children's health status was scored across eight attributes of the HUI3-vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain, and these were used to calculate a multi-attribute utility score. Ordinary least squares (OLS), Tobit and two-part regressions were used to model the association between weight status and multi-attribute utility. RESULTS Of the 368 children for whom weight status and HUI3 data were available, around 40% had overweight/obesity. After adjusting for child's sex, maternal education, marital status and household income, no significant association between weight status in the preschool years and multi-attribute utility scores at 5 years was found. CONCLUSIONS Alternative approaches for capturing the effects of weight status in the preschool years on preference-based HRQoL outcomes should be tested. The application of the QALY framework to economic evaluations of obesity-related interventions in young children should also consider longitudinal effects over the life-course. Clinical Trial Registration The Healthy Beginnings Trial was registered with the Australian Clinical Trial Registry (ACTRNO12607000168459).
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Affiliation(s)
- Eng Joo Tan
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia. .,The NHMRC Centre of Research Excellence in The Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Victoria Brown
- The NHMRC Centre of Research Excellence in The Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia.,Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia.,Global Obesity Centre, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Stavros Petrou
- The NHMRC Centre of Research Excellence in The Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia.,Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Mario D'Souza
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.,Clinical Research Centre, Sydney Local Health District, Sydney, NSW, Australia
| | - Marjory L Moodie
- The NHMRC Centre of Research Excellence in The Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia.,Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia.,Global Obesity Centre, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Li Ming Wen
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.,The NHMRC Centre of Research Excellence in The Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia.,Health Promotion Service, Sydney Local Health District, Sydney, Australia
| | - Louise A Baur
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.,The NHMRC Centre of Research Excellence in The Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Chris Rissel
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.,The NHMRC Centre of Research Excellence in The Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Alison J Hayes
- The University of Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.,The NHMRC Centre of Research Excellence in The Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
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Frew E, Ng SW, Coast J, Hollingsworth B, Smith R. How Can Economics Help Tackle Obesity? Obesity (Silver Spring) 2018; 26:1112-1113. [PMID: 29901263 PMCID: PMC6032902 DOI: 10.1002/oby.22211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Emma Frew
- Health Economics UnitUniversity of BirminghamBirminghamUK
| | - Shu Wen Ng
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Joanna Coast
- Population Health SciencesUniversity of BristolBristolUK
| | | | - Richard Smith
- Faculty of Public Health & PolicyLondon School of Hygiene and Tropical MedicineLondonUK
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Milliken OV, Ellis VL. Development of an investment case for obesity prevention and control: perspectives on methodological advancement and evidence. Rev Panam Salud Publica 2018; 42:e62. [PMID: 31093090 PMCID: PMC6385999 DOI: 10.26633/rpsp.2018.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/22/2018] [Indexed: 12/13/2022] Open
Abstract
This paper opens a discussion on the main features of an investment case for obesity prevention and control, by scanning available evidence on existing approaches and by highlighting contextual considerations and evidence for Latin America and the Caribbean. We call on researchers and analysts in the field to update and broaden existing methods of economic analyses to better reflect the multisectoral nature of an investment case for obesity prevention and control. We also identify research gaps and further work required to advance methods and evidence towards investment cases throughout the Americas.
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Affiliation(s)
- Olga V. Milliken
- Centre for Chronic Disease Prevention and Health Equity and WHO Collaborating Centre on Noncommunicable Disease Policy, Public Health Agency of Canada, Ottawa, Canada
| | - Vivian L. Ellis
- Centre for Chronic Disease Prevention and Health Equity and WHO Collaborating Centre on Noncommunicable Disease Policy, Public Health Agency of Canada, Ottawa, Canada
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Zanganeh M, Adab P, Li B, Frew E. Protocol for a systematic review of methods and cost-effectiveness findings of economic evaluations of obesity prevention and/or treatment interventions in children and adolescents. Syst Rev 2018; 7:54. [PMID: 29609652 PMCID: PMC5879570 DOI: 10.1186/s13643-018-0718-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/22/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Childhood obesity is a major global public health problem, with governments increasingly having to undertake various strategies to reduce excess weight in their populations. Considering the increasing number of well-conducted intervention studies in the field of childhood obesity prevention, there are relatively few published economic evaluations. The proposed systematic review will explore the methods of these economic evaluations, examine the limitations and establish the evidence base for cost-effectiveness analyses. METHODS/DESIGN Systematic review methodology will be applied to identify, select and extract data from published economic evaluation studies (trial-based, non-trial based, simulation-based, decision model and trial based model economic evaluations) of obesity prevention and/or treatment interventions in children and adolescents. A systematic literature search will be conducted using bibliographic databases (MEDLINE, EMBASE, CINAHL, Web of Science, EconLit, PsycINFO, Cochrane Library, Centre for Reviews and Dissemination (CRD) and Cost-Effectiveness Analysis (CEA) Registry). The review will only include full economic evaluations. There will be no restrictions based on language, perspective, follow-up duration, sample size, country or setting. To minimise selection bias, translation of non-English language articles will be undertaken. The quality of included studies will be assessed. Following data extraction, a narrative synthesis of the results from the included studies will be undertaken. Subgroup analysis will be considered where deemed appropriate. DISCUSSION The findings from this review, which will include primary studies, will provide evidence to assist health policy decision makers interpret economic evaluations in this field. In addition, we will identify gaps in the current literature to inform future-related research. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42017062236.
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Affiliation(s)
- Mandana Zanganeh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bai Li
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Blank N, Hegenbart U, Dietrich S, Brune M, Beimler J, Röcken C, Müller-Tidow C, Lorenz HM, Schönland SO. Obesity is a significant susceptibility factor for idiopathic AA amyloidosis. Amyloid 2018; 25:37-45. [PMID: 29364741 DOI: 10.1080/13506129.2018.1429391] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND To investigate obesity as susceptibility factor in patients with idiopathic AA amyloidosis. METHODS Clinical, biochemical and genetic data were obtained from 146 patients with AA amyloidosis. Control groups comprised 40 patients with long-standing inflammatory diseases without AA amyloidosis and 56 controls without any inflammatory disease. FINDINGS Patients with AA amyloidosis had either familial Mediterranean fever (FMF) or long-standing rheumatic diseases as underlying inflammatory disease (n = 111, median age 46 years). However, in a significant proportion of patients with AA amyloidosis no primary disease was identified (idiopathic AA; n = 37, median age 60 years). Patients with idiopathic AA amyloidosis were more obese and older than patients with AA amyloidosis secondary to FMF or rheumatic diseases. Serum leptin levels correlated with the body mass index (BMI) in all types of AA amyloidosis. Elevated leptin levels of more than 30 µg/l were detected in 18% of FMF/rheumatic + AA amyloidosis and in 40% of patients with idiopathic AA amyloidosis (p = .018). Finally, the SAA1 polymorphism was confirmed as a susceptibility factor for AA amyloidosis irrespective of the type of the disease. CONCLUSIONS Obesity, age and the SAA1 polymorphism are susceptibility factors for idiopathic AA amyloidosis. Recent advances in treatment of FMF and rheumatic disorders will decrease the incidence of AA amyloidosis due to these diseases. Idiopathic AA, however, might be an emerging problem in the ageing and increasingly obese population.
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Affiliation(s)
- Norbert Blank
- a Department of Medicine V, Amyloidosis Center and Division of Hematology, Oncology and Rheumatology , University of Heidelberg , Heidelberg , Germany
| | - Ute Hegenbart
- a Department of Medicine V, Amyloidosis Center and Division of Hematology, Oncology and Rheumatology , University of Heidelberg , Heidelberg , Germany
| | - Sascha Dietrich
- a Department of Medicine V, Amyloidosis Center and Division of Hematology, Oncology and Rheumatology , University of Heidelberg , Heidelberg , Germany
| | - Maik Brune
- b Department of Medicine I, Endocrinology and Clinical Laboratory Medicine , University of Heidelberg , Heidelberg , Germany
| | - Jörg Beimler
- c Department of Medicine I, Division of Nephrology , University of Heidelberg , Heidelberg , Germany
| | | | - Carsten Müller-Tidow
- a Department of Medicine V, Amyloidosis Center and Division of Hematology, Oncology and Rheumatology , University of Heidelberg , Heidelberg , Germany
| | - Hanns-Martin Lorenz
- a Department of Medicine V, Amyloidosis Center and Division of Hematology, Oncology and Rheumatology , University of Heidelberg , Heidelberg , Germany
| | - Stefan O Schönland
- a Department of Medicine V, Amyloidosis Center and Division of Hematology, Oncology and Rheumatology , University of Heidelberg , Heidelberg , Germany
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Abstract
Obesity in adolescence will probably have major implications not only for the affected adolescents but also for society. Those who have obesity during adolescence usually have obesity into adulthood, which causes many medical and psychological issues that can result in premature death. Furthermore, obesity in adolescents is associated with a range of social problems, including difficulties securing an apprenticeship or a job or finding a partner. Adolescents with obesity are also at increased risk of having children with obesity later in life. All these consequences lead to high costs for the health-care system. Although efficient treatment options are available that have been proven in randomized controlled trials, such as lifestyle interventions for adolescents with obesity and bariatric surgery for adolescents with severe obesity, these interventions frequently fail in clinical practice as treatment adherence is low in adolescents and most adolescents with obesity do not seek medical care. Therefore, improving treatment adherence and identifying treatment barriers are necessary.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. Friedrich Steiner Street 5, Datteln 45711, Germany
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Döring N, Zethraeus N, Tynelius P, de Munter J, Sonntag D, Rasmussen F. Economic Evaluation of PRIMROSE-A Trial-Based Analysis of an Early Childhood Intervention to Prevent Obesity. Front Endocrinol (Lausanne) 2018; 9:104. [PMID: 29593658 PMCID: PMC5861136 DOI: 10.3389/fendo.2018.00104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/02/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood obesity is a major clinical and economic health concern. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector. This study is one of the first efforts to provide evidence by assessing the effects and costs of a population-based primary prevention intervention targeting pre-school children attending child health centers in Sweden. METHODS The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among pre-school children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period from a societal perspective. The primary outcome was BMI at age 4. Cost data was prospectively collected alongside the trial. Scenario analyses were carried out to identify uncertainty. RESULTS The estimated additional mean total costs of the PRIMROSE intervention were 342 Euro (95% CI: 334; 348) per child. During pre-school years direct costs mainly consist of training costs and costs for the additional time used by nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents' absence from work due to their participation in the intervention. The incremental cost-effectiveness ratio in the base case analysis was 3,109 Euro per 1 BMI unit prevented. CONCLUSION We cannot provide evidence that the PRIMROSE intervention is cost-effective, given the uncertainty in the effect measure. Until further evidence is provided, we recommend resources to be spent elsewhere within the field of obesity prevention. Furthermore, to achieve valid and reliable cost-effectiveness results, the economic evaluation of obesity prevention programs in early childhood should incorporate the life time impact to capture all relevant costs and benefits.
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Affiliation(s)
- Nora Döring
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Nora Döring,
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jeroen de Munter
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Diana Sonntag
- Medical Faculty of Heidelberg University, Mannheim Institute of Public Health, Social Prevention and Medicine (MIPH), Mannheim, Germany
- Department of Health Science, University of York, York, United Kingdom
| | - Finn Rasmussen
- Department of Health Sciences, Lund University, Lund, Sweden
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