The cost-effectiveness of child obesity intervention

Childhood obesity has increasingly come to be recognized as a health problem globally. A number of interventions have been implemented in the attempt to reduce the prevalence of obesity in children, involving both curative and preventive measures. Efforts to tackle childhood obesity take a variety of forms, including medicinal, behavioural, school-based, and other types of interventions. Despite considerable efforts to reduce childhood obesity, however, there is as of yet no evidence-based standard protocol for either treatment or prevention. One potential deterrent to the adoption of an intervention is the uncertainty of return on investment, due largely to unclear future benefits gained from the various interventions, as well as poor cost measurement. This is because most of the health benefits of child obesity interventions are not revealed until adulthood, making health gains from the interventions difficult to observe. Moreover, there is no method to assess the future medical costs saved due to the reduced prevalence of obesity in childhood. Modelling the costs and benefits of the interventions is therefore crucial, especially in making policy decisions as to which interventions are worth implementing using public funding. Cost-effectiveness analysis is an economic evaluation method used in resource allocation that compares the costs and benefits of competing alternatives. The author explores evidence regarding the cost-effectiveness of child obesity interventions, with the aim of making contributions to the existing body of knowledge in this field. The first chapter provides an overview of obesity in childhood, addressing such issues as epidemiology, definition, aetiology, and physical and social consequences. The author then conducts a literature review of the cost-effectiveness of child obesity interventions, with results showing that only a handful of high-quality published studies are available. In order to perform the cost-effectiveness analysis, MEND 7-13, a child obesity intervention that aims to treat obese children aged 7 to 13, is used as a case study. The author explores the background of the MEND 7-13 programme and assesses the extent to which various characteristics of participants affect the benefits uptake of the programme. The data used in the analysis come from the MEND rollout phase, which lasted from January 2007 to December 2009 and included 6,828 participants, with an average follow-up duration of 10 weeks. The results showed that significant predictors of BMI change in White children are gender, programme attendance rate, and baseline BMI; for Asian children, the only significant predictor is having parents who own their own houses; no evidence of association is shown in Black children; and total attendance and gender are significant predictors in the ‘Other’ group. The results also showed that the programme centre influences the change in BMI to some extent in all children. The effectiveness of the MEND rollout programme, derived from the MEND rollout data, is used in the cost-effectiveness analysis. An economic modelling technique is developed and employed based on the assumption that MEND 7-13 is available to all children who meet the eligibility criteria in England in 2010. The intervention costs and medical costs saved due to the programme are estimated to be £551.2 million and £216 million, respectively. 200,910 incremental QALYs are gained, leading to an estimated ICER of £1,668.2 per QALY. The author performs a sensitivity analysis using Monte Carlo methods to assess the effect of parameter uncertainty on the cost-effectiveness outcomes. The strengths and weaknesses of the economic modelling techniques are then discussed, with emphasis on the knowledge contributed by this thesis to the existing literature. The author also points out the research and policy implications of the results, alongside recommendations for future research.