Cost-effectiveness of community-based childhood obesity prevention interventions in Australia

• DOI: 10.1038/s41366-019-0341-0
• Publication Date: 2019-03-29T12:04:53Z
• Authors: Jaithri Ananthapavan; Phuong K. Nguyen; Steven J. Bowe; Gary Sacks; Ana Maria Mantill...; Boyd Swinburn; Vicki Brown; Rohan Sweeney; Anita Lal; Claudia Strugnell; Marj Moodie
• Keywords: Male; Pediatric Obesity; Adolescent; Cost-Benefit Analysis; Medicine (miscellaneous); Health Promotion; 796; 03 medical and health sciences; Endocrinology; 0302 clinical medicine; Humans; Community Health Services; Child; Exercise; 360; 2. Zero hunger; Nutrition and Dietetics; Australia; 1. No poverty; 2701 Medicine (miscellaneous); 3. Good health; Diabetes and Metabolism; Primary Prevention; 2712 Endocrinology; 2916 Nutrition and Dietetics; Female; Diet, Healthy

The objective of this study is to examine, from a limited societal perspective, the cost-effectiveness of community-based obesity prevention interventions (CBIs)-defined as a programme of community-level strategies to promote healthy eating and physical activity for Australian children (aged 5-18 years).The effectiveness of CBIs was determined by undertaking a literature review and meta-analysis. Commonly implemented strategies to increase physical activity and improve nutrition were costed (in 2010 Australian dollars) to determine the average cost of a generic programme. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the lifetime of the target population. Monte-Carlo simulation was used to assess second-order uncertainty of input parameters to estimate mean incremental cost-effectiveness ratios (ICER) with 95% uncertainty intervals (UIs). Scenario analyses tested variations in programme intensity, target population, and duration of effect.The meta-analysis revealed a small but significant difference in BMI z-score (mean difference of - 0.07 (95% UI: - 0.13 to - 0.01)) favouring the CBI community compared with the control. The estimated net cost of implementing CBIs across all local government areas (LGAs) in Australia was AUD426M (95% UI: AUD3M to AUD823M) over 3 years. This resulted in 51,792 HALYs gained (95% UI: 6816 to 96,972) over the lifetime of the cohort. The mean ICER was AUD8155 per HALY gained (95% UI: AUD237 to AUD81,021), with a 95% probability of being cost-effective at a willingness to pay threshold of AUD50,000 per HALY.CBIs are cost-effective obesity prevention initiatives; however, implementation across Australia will be (relatively) expensive when compared with current investments in preventive health.