Cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children.
OBJECTIVE
To assess from a societal perspective the incremental cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children. The intervention was modelled on the LEAP (live, eat and play) trial, a randomised controlled trial conducted by the Centre for Community Child Health, Melbourne, Australia in 2002-2003. This study was undertaken as part of the assessing cost-effectiveness (ACE) in obesity project which evaluated, using consistent methods, 13 interventions targeting unhealthy weight gain in children and adolescents.


METHODS
A logic pathway was used to model the effects of the intervention compared to no intervention on body mass index (BMI) and health outcomes (disability-adjusted life years-DALYs). Disease costs and health benefits were tracked until the cohort of eligible children reached the age of 100 years or death. Simulation-modelling techniques were used to present a 95% uncertainty interval around the cost-effectiveness ratio. The intervention was also assessed against a series of filters ('equity', 'strength of evidence', 'acceptability', 'feasibility', sustainability' and 'side-effects') to incorporate additional factors that impact on resource allocation decisions.


RESULTS
The intervention, as modelled, reached 9685 children aged 5-9 years with a BMI z-score of >or=3.0, and cost $AUD6.3M (or $AUD4.8M excluding time costs). It resulted in an incremental saving of 2300 BMI units which translated to 511 DALYs. The cost-offsets stemming from the intervention totalled $AUD3.6M, resulting in a net cost per DALY saved of $AUD4670 (dominated; $0.1M) (dominated means intervention costs more for less effect).


CONCLUSIONS
Compared to a 'no intervention' control group, the intervention was cost-effective under current assumptions, although the uncertainty intervals were wide. A key question related to the long-term sustainability of the small incremental weight loss reported, based on the 9-month follow-up results for LEAP.
Moodie
Marjory
M
Health Economics Unit, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia. marj.moodie@deakin.edu.au
Haby
Michelle
M
Wake
Melissa
M
Gold
Lisa
L
Carter
Robert
R
D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000191:economics* / Q000517:prevention & control / Q000628:therapy*; D050177:Overweight; D019057:Quality-Adjusted Life Years