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Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control
Louise Tully1, Jan Sorensen2, Grace O'Malley1,3
1Obesity Research and Care Group, Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.
Insights
Mobile health (mHealth) interventions for pediatric weight management are more expensive than usual care. Further research is needed to explore cost-effectiveness and broader economic impacts.
Area of Science:
- Health Economics
- Digital Health
- Pediatric Obesity
Background:
- Mobile health (mHealth) offers potential to improve pediatric weight management and service accessibility.
- Despite growing evidence of effectiveness, economic evaluations of mHealth interventions are scarce.
Purpose of the Study:
- To assess the economic viability of an mHealth approach compared to standard multidisciplinary care.
- To evaluate direct costs within a noninferiority randomized controlled trial (RCT).
Main Methods:
- A digitally delivered pediatric weight management program was developed iteratively.
- Microcosting and budget impact analysis were used from a healthcare system perspective.
- Resource use and costs of staff time were analyzed alongside the RCT.
Main Results:
- The mean direct cost per adolescent was €142 for usual care versus €722 for the mHealth group.
- Costs varied based on treatment completion weeks and dropout points.
- Health professional monitoring was the primary cost driver in the mHealth arm.
Conclusions:
- The mHealth approach was substantially more expensive than usual care.
- Modifications may reduce mHealth costs, but professional support remains necessary.
- Further research on cost-effectiveness and broader economic impacts is required.
Background:
Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions.
Objective:
We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT).
Methods:
A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant.
Results:
In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach.
Conclusions:
This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective.
Trial Registration:
ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855.
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