Abstract
Objective:
To estimate lifetime cost effectiveness of lifestyle interventions to treat overweight and obese children, from the UK National Health Service perspective.
Design:
An adaptation of the National Heart Forum economic model to predict lifetime health service costs and outcomes of lifestyle interventions on obesity-related diseases.
Setting:
Hospital or community-based weight-management programmes.
Population:
Hypothetical cohorts of overweight or obese children based on body mass data from the National Child Measurement Programme.
Interventions:
Lifestyle interventions that have been compared with no or minimal intervention in randomized controlled trials (RCTs).
Main Outcome Measures:
Reduction in body mass index (BMI) standard deviation score (SDS), intervention resources/costs, lifetime treatment costs, obesity-related diseases and cost per life year gained.
Results:
Ten RCTs were identified by our search strategy. The median effect of interventions versus control from these 10 RCTs was a difference in BMI SDS of −0.13 at 12 months, but the range in effects among interventions was broad (0.04 to −0.60). Indicative costs per child of these interventions ranged from £108 to £662. For obese children aged 10–11 years, an intervention that resulted in a median reduction in BMI SDS at 12 months at a moderate cost of £400 increased life expectancy by 0.19 years and intervention costs were offset by subsequent undiscounted savings in treatment costs (net saving of £110 per child), though this saving did not emerge until the sixth or seventh decade of life. The discounted cost per life year gained was £13 589. Results were broadly similar for interventions aimed at children aged 4–5 years and which targeted both obese and overweight children. For more costly interventions, savings were less likely.
Conclusion:
Interventions to treat childhood obesity are potentially cost effective although cost savings and health benefits may not appear until the sixth or seventh decade of life.
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Acknowledgements
We are grateful for help provided by John Twigger, Emily Van De Venter, Helen Yeo and Helen Tapson the public health analysts at NHS Bristol, South Gloucestershire, Bath and North East Somerset and North Somerset in accessing the NCMP data. We are grateful for permission from the National Heart Forum to use the NHF obesity model and for the advice given by Tom Byatt on the model. The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES-590-28-0005), Medical Research Council, the Welsh Assembly Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The research was funded by NHS Bristol.
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The funder had no role in the development of the study design, data analyses and interpretation, writing of the article or the decision to submit for publication. All authors had full access to all of the data and can take responsibility for the integrity of the data and the accuracy of the data analysis.
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RK was employed by the South West Public Health Training Programme on secondment to the University of Bristol during this work and her employment contract was hosted by NHS Bristol. DAL works in a Centre that receives support from the UK Medical Research Council (G0600705) and the University of Bristol. RRK was receiving funds from the South West NHS Public Health training scheme during the time that she worked on this project.
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Hollingworth, W., Hawkins, J., Lawlor, D. et al. Economic evaluation of lifestyle interventions to treat overweight or obesity in children. Int J Obes 36, 559–566 (2012). https://doi.org/10.1038/ijo.2011.272
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DOI: https://doi.org/10.1038/ijo.2011.272