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Economic evaluation of lifestyle interventions to treat overweight or obesity in children |
Hollingworth W, Hawkins J, Lawlor DA, Brown M, Marsh T, Kipping RR |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study aimed to estimate the cost-effectiveness of lifestyle interventions, for overweight or obese children, in primary school, over their lifetime. The authors concluded that the interventions could have benefits and be cost saving, but only after six or seven decades. The methods seem to have been appropriate, and were clearly and transparently reported. The conclusions reached by the authors appear to be appropriate. Type of economic evaluation Cost-effectiveness analysis Study objective The objective was to estimate the cost-effectiveness of lifestyle interventions, for overweight or obese children, in primary school, over their lifetime. Interventions The lifestyle interventions were those that had been evaluated in randomised controlled trials of children of primary school age. The comparator was no intervention. The interventions were grouped into high, medium or low cost, based on the reported costs or the number of intervention sessions. Location/setting UK/primary and community care. Methods Analytical approach:The authors used a model developed by the National Heart Forum (McPherson, et al. 2007, see Other Publications of Related Interest) to synthesise data from published literature and surveys. Two weight groups (obese only or overweight and obese) and two age groups (4 to 5 or 10 to 11 years) were simulated. The time horizon was lifetime. The authors stated that the costs and savings from the UK NHS perspective were considered. Effectiveness data:The authors updated a published Cochrane systematic literature review of obesity treatment (Oude-Luttikhuis, et al. 2009, see Other Publications of Related Interest), to identify randomised controlled trials of lifestyle interventions for obese or overweight children of primary school age. The review sought trials published up to the year 2010, in MEDLINE. The data from 10 trials were used to estimate the outcomes for a cohort of 50,000 children, whose characteristics were based on the age, gender, and body mass index (BMI) of children in four regions in South West England who participated in the National Child Measurement Programme 2008/9. The main clinical effectiveness estimates were the effect size in BMI standard deviation score reduction, from the intervention to 12 months; life-years saved; and the incidence of obesity-related disease. Monetary benefit and utility valuations:Not relevant. Measure of benefit:Life-years gained were the summary benefit measure. Discounted and undiscounted results were reported, with future benefits discounted at a rate of 3.5%. Cost data:The costs included the lifestyle intervention and the lifetime costs of overweight- or obesity-related diseases, to the NHS. The cost of the lifestyle intervention was based on the minimum, maximum, and median costs from the published literature. Where necessary, costs were converted to UK £, using the Organisation for Economic Co-operation and Development purchasing power parity values for 2009. The costs to the NHS were based on national programme budgets, for five major weight-related diseases, divided by their estimated prevalence, to give a cost per person per year. Future costs were discounted at a rate of 3.5%; discounted and undiscounted results were reported. Analysis of uncertainty:The sensitivity analysis consisted of the nine scenarios with minimum, median, and maximum effect size, and low, moderate, and high intervention costs, for the four cohorts by weight and age. Results In 10 to 11 year olds, the life expectancy was 72.16 years with no intervention, and 72.35 years with lifestyle interventions (a gain of 0.19 years), assuming a median effect size (-0.13 BMI SD score reduction). The gain in life expectancy was 0.02 years, assuming a minimum effect size (-0.03 BMI SD score reduction) and 1.01 years, assuming a maximum effect size (-0.60 BMI SD score reduction). The lifetime cost was £13,967 with no intervention, £14,242 with a minimum effect size, £13,857 with a median effect size, and £12,240 with a maximum effect size, assuming the moderate intervention cost of £400. Assuming the moderate cost intervention, the discounted incremental cost per life-year gained was £66,567 (£16,898 without discounting) with a minimum effect size, and £13,589 with a median effect size. With a median effect size, without discounting, the intervention dominated usual care, as it was cheaper and more effective, and it dominated with a large effect size, with or without discounting. Authors' conclusions The authors concluded that interventions to treat childhood obesity could have health benefits and be cost saving, but only after six or seven decades. CRD commentary Interventions:The rationale for the selection of the interventions was clearly described. The grouping of interventions according to cost may not have been appropriate. The comparator was no intervention, which was the usual practice in the UK. Effectiveness/benefits:The methods used to identify and select the trials that supplied the clinical data were well reported. The methods used to combine these data for the clinical estimates were described in sufficient detail. Most of the estimates were from randomised controlled trials, which are likely to have had good internal validity. It appears that the best available evidence was used. Costs:The cost categories were consistent with the perspective stated. The sources for the resource use and prices were described. The costs were calculated crudely, and may have omitted some important cost savings, but they were consistent with the approach adopted by the authors. The costs were converted to UK £ using purchasing parity values for 2009, but it was unclear whether other adjustments were made to a price year. Analysis and results:The authors appropriately presented the evidence of the relative cost-effectiveness of the interventions, based on the number of sessions or cost of the programme. They explored the impact of uncertainty to some extent, by analysing all combinations of these scenarios, but the basic definition of the interventions and costs might restrict the generalisability of the results. The reporting of the study and its results was generally good, with details provided in supplementary files. The authors discussed the limitations of their study in detail and made recommendations for research. Concluding remarks:The methods seem to have been appropriate, and were clearly and transparently reported. The conclusions reached by the authors appear to be appropriate. Funding Funding received from the NHS Bristol, British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Assembly Government, and the Wellcome Trust. Bibliographic details Hollingworth W, Hawkins J, Lawlor DA, Brown M, Marsh T, Kipping RR. Economic evaluation of lifestyle interventions to treat overweight or obesity in children. International Journal of Obesity 2012; 36(4): 559-566 Other publications of related interest Oude-Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database of Systematic Reviews 2009; 1: CD001872. McPherson K, Marsh T, Brown M. Tacking obesities: future choices - modelling future trends in obesity and the impact on health. Second edition. UK Government Foresight, 2007. Indexing Status Subject indexing assigned by NLM MeSH Body Mass Index; Child; Child, Preschool; Cost-Benefit Analysis; Female; Great Britain /epidemiology; Humans; Male; Models, Economic; National Health Programs; Obesity /economics; Overweight /economics /epidemiology /prevention & Randomized Controlled Trials as Topic; Risk Reduction Behavior; control /therapy AccessionNumber 22012017386 Date bibliographic record published 30/01/2013 Date abstract record published 21/02/2013 |
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