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Cost-effectiveness of community-based childhood obesity prevention interventions in Australia
Jaithri Ananthapavan1,2, Phuong K Nguyen3,4, Steven J Bowe5
1Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia. jaithri.ananthapavan@deakin.edu.au.
Insights
Community-based obesity prevention interventions (CBIs) are cost-effective for Australian children. While effective in reducing BMI, widespread implementation requires significant investment compared to current preventive health spending.
Area of Science:
- Public Health
- Health Economics
- Preventive Medicine
Background:
- Childhood obesity is a significant public health concern in Australia.
- Community-based interventions (CBIs) offer a strategy to promote healthy eating and physical activity.
- Assessing the cost-effectiveness of CBIs is crucial for resource allocation in preventive health.
Purpose of the Study:
- To evaluate the cost-effectiveness of community-based obesity prevention interventions (CBIs) for Australian children (aged 5-18 years).
- To assess health benefits, including health-adjusted life years (HALYs) gained and healthcare cost offsets.
- To determine the incremental cost-effectiveness ratio (ICER) from a limited societal perspective.
Main Methods:
- Literature review and meta-analysis to determine CBI effectiveness on BMI z-score.
- Costing of common physical activity and nutrition strategies to estimate program costs.
- A Markov model simulating obesity-related diseases to estimate long-term health and economic outcomes.
- Monte-Carlo simulations for uncertainty analysis and scenario testing.
Main Results:
- Meta-analysis showed a significant reduction in BMI z-score (mean difference -0.07) in communities with CBIs.
- Estimated net cost for nationwide CBI implementation over 3 years was AUD426 million.
- CBIs are projected to gain 51,792 HALYs over the cohort's lifetime.
- The mean ICER was AUD8155 per HALY gained, with a 95% probability of cost-effectiveness at AUD50,000 per HALY.
Conclusions:
- Community-based obesity prevention interventions are a cost-effective strategy for Australian children.
- Widespread implementation of CBIs across Australia represents a substantial investment compared to current preventive health expenditure.
- The findings support the adoption of CBIs, while acknowledging the need for significant funding.
Objectives:
The objective of this study is to examine, from a limited societal perspective, the cost-effectiveness of community-based obesity prevention interventions (CBIs)-defined as a programme of community-level strategies to promote healthy eating and physical activity for Australian children (aged 5-18 years).
Methods:
The effectiveness of CBIs was determined by undertaking a literature review and meta-analysis. Commonly implemented strategies to increase physical activity and improve nutrition were costed (in 2010 Australian dollars) to determine the average cost of a generic programme. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the lifetime of the target population. Monte-Carlo simulation was used to assess second-order uncertainty of input parameters to estimate mean incremental cost-effectiveness ratios (ICER) with 95% uncertainty intervals (UIs). Scenario analyses tested variations in programme intensity, target population, and duration of effect.
Results:
The meta-analysis revealed a small but significant difference in BMI z-score (mean difference of - 0.07 (95% UI: - 0.13 to - 0.01)) favouring the CBI community compared with the control. The estimated net cost of implementing CBIs across all local government areas (LGAs) in Australia was AUD426M (95% UI: AUD3M to AUD823M) over 3 years. This resulted in 51,792 HALYs gained (95% UI: 6816 to 96,972) over the lifetime of the cohort. The mean ICER was AUD8155 per HALY gained (95% UI: AUD237 to AUD81,021), with a 95% probability of being cost-effective at a willingness to pay threshold of AUD50,000 per HALY.
Conclusions:
CBIs are cost-effective obesity prevention initiatives; however, implementation across Australia will be (relatively) expensive when compared with current investments in preventive health.
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