The costs, effects and cost-effectiveness of counteracting overweight on a population level. A scientific base for policy targets for the Dutch national plan for action.
OBJECTIVE
To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive lifestyle program (applied to 10% of overweight adults), and costs and cost-effectiveness were assessed.


METHODS
Costs and effects were based on two Dutch projects and verified by similar international projects. A markov-type simulation model estimated long-term health benefits, health care costs and cost-effectiveness.


RESULTS
Combined implementation of the interventions--at the above mentioned scale--reduces prevalence rates of overweight by approximately 3 percentage points and of physical inactivity by 2 percentage points after 5 years, at a cost of 7 euros per adult capita per year. The cost-effectiveness ratio of combined implementation amounts to euro 6000 per life-year gained and euro 5700 per QALY gained (including costs of unrelated diseases in life years gained). Sensitivity analyses showed that these ratios are quite robust.


CONCLUSIONS
A realistic policy target is a decrease in overweight prevalence of three percentage points, compared to a situation with no interventions. In reality, large scale implementation of the interventions may not counteract the expected upward trends in The Netherlands completely. Nonetheless, implementation of the interventions is cost-effective.
Bemelmans
Wanda
W
National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Wanda.bemelmans@rivm.nl
van Baal
Pieter
P
Wendel-Vos
Wanda
W
Schuit
Jantine
J
Feskens
Edith
E
Ament
Andre
A
Hoogenveen
Rudolf
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006291:Health Policy; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008019:Life Style; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D009426:Netherlands / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control*; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years