title: Economic Evaluation of Obesity Prevention in Early Childhood: Methods, Limitations and Recommendations.
abstract: Despite methodological advances in the field of economic evaluations of interventions, economic evaluations of obesity prevention programmes in early childhood are seldom conducted. The aim of the present study was to explore existing methods and applications of economic evaluations, examining their limitations and making recommendations for future cost-effectiveness assessments. A systematic literature search was conducted using PubMed, Cochrane Library, the British National Health Service Economic Evaluation Databases and EconLit. Eligible studies included trial-based or simulation-based cost-effectiveness analyses of obesity prevention programmes targeting preschool children and/or their parents. The quality of included studies was assessed. Of the six studies included, five were intervention studies and one was based on a simulation approach conducted on secondary data. We identified three main conceptual and methodological limitations of their economic evaluations: Insufficient conceptual approach considering the complexity of childhood obesity, inadequate measurement of effects of interventions, and lack of valid instruments to measure child-related quality of life and costs. Despite the need for economic evaluations of obesity prevention programmes in early childhood, only a few studies of varying quality have been conducted. Moreover, due to methodological and conceptual weaknesses, they offer only limited information for policy makers and intervention providers. We elaborate reasons for the limitations of these studies and offer guidance for designing better economic evaluations of early obesity prevention.
authors.affiliation: Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm 17177, Sweden. nora.doering@ki.se.
authors.forename: Nora
authors.initials: N
authors.lastname: Döring
authors.affiliation: Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna 1090, Austria. susanne.mayer@meduniwien.ac.at.
authors.forename: Susanne
authors.initials: S
authors.lastname: Mayer
authors.affiliation: Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm 17177, Sweden. finn.rasmussen@ki.se.|Health Care Services, Stockholm County Council, Centre for Epidemiology and Community Medicine, Stockholm 17129, Sweden. finn.rasmussen@ki.se.
authors.forename: Finn
authors.initials: F
authors.lastname: Rasmussen
authors.affiliation: Mannheim Institute of Public Health, Social Prevention and Medicine (MIPH), Medical Faculty of Heidelberg University, Mannheim 68167, Germany. mail@diana-sonntag.eu.|Department of Health Science, University of York, Heslington, York YO10 5DD, UK. mail@diana-sonntag.eu.
authors.forename: Diana
authors.initials: D
authors.lastname: Sonntag
mesh_terms: D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D010290:Parents; D063766:Pediatric Obesity / Q000191:economics* / Q000517:prevention & control*; D011788:Quality of Life; D013222:State Medicine
keywords: cost effectiveness; early childhood; methods; obesity; prevention