The cost of a primary care-based childhood obesity prevention intervention.
BACKGROUND
United States pediatric guidelines recommend that childhood obesity counseling be conducted in the primary care setting. Primary care-based interventions can be effective in improving health behaviors, but also costly. The purpose of this study was to evaluate the cost of a primary care-based obesity prevention intervention targeting children between the ages of two and six years who are at elevated risk for obesity, measured against usual care.


METHODS
High Five for Kids was a cluster-randomized controlled clinical trial that aimed to modify children's nutrition and TV viewing habits through a motivational interviewing intervention. We assessed visit-related costs from a societal perspective, including provider-incurred direct medical costs, provider-incurred equipment costs, parent time costs and parent out-of-pocket costs, in 2011 dollars for the intervention (n = 253) and usual care (n =192) groups. We conducted a net cost analysis using both societal and health plan costing perspectives and conducted one-way sensitivity and uncertainty analyses on results.


RESULTS
The total costs for the intervention group and usual care groups in the first year of the intervention were $65,643 (95% CI [$64,522, $66,842]) and $12,192 (95% CI [$11,393, $13,174]). The mean costs for the intervention and usual care groups were $259 (95% CI [$255, $264]) and $63 (95% CI [$59, $69]) per child, respectively, for a incremental difference of $196 (95% CI [$191, $202]) per child. Children in the intervention group attended a mean of 2.4 of a possible 4 in-person visits and received 0.45 of a possible 2 counseling phone calls. Provider-incurred costs were the primary driver of cost estimates in sensitivity analyses.


CONCLUSIONS
High Five for Kids was a resource-intensive intervention. Further studies are needed to assess the cost-effectiveness of the intervention relative to other pediatric obesity interventions.
Department of Pediatrics, University of Washington School of Medicine, PO Box 5371, M/S: CW-8-6, 98145-5005 Seattle, Washington, USA. davene.wright@seattlechildrens.org.
Davene R
DR
Wright
Elsie M
EM
Taveras
Matthew W
MW
Gillman
Christine M
CM
Horan
Katherine H
KH
Hohman
Steven L
SL
Gortmaker
Lisa A
LA
Prosser
D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D062405:Motivational Interviewing / Q000191:economics / Q000379:methods; D010290:Parents; D063766:Pediatric Obesity / Q000191:economics / Q000517:prevention & control*; D011320:Primary Health Care / Q000191:economics / Q000379:methods*