A systematic review of economic evaluations of interventions targeting childhood overweight and obesity

Abstract

Summary This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One‐hundred fifty‐one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention‐only (13 studies), prevention and treatment (100 studies), and treatment‐only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost‐effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost‐effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home‐based general practitioner consultations, tended to be cost‐effective. However, cost‐effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.

Interpreting Cost-Effectiveness Analyses of Anti-Obesity Medications for the Treatment of Adolescent Obesity—Reading the Tea Leaves

“…Research on adolescent obesity frequently uses various usual care and lifestyle interventions as the base case comparator. 4 Second, there are several common outcomes assessed in CEAs. Health benefits can be quantified by health outcomes (eg, body mass index [BMI]), life expectancy, and quality-adjusted life-years (QALYs), a composite measure of quality of life and life expectancy.…”

“…First, regarding the candidate interventions, Lim et al considered IHBLT alone and adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide. Research on adolescent obesity frequently uses various usual care and lifestyle interventions as the base case comparator . Second, there are several common outcomes assessed in CEAs.…”

“…In this case, Lim et al compared ICERs with a commonly used WTP threshold of $100 000 per QALY gained . WTP thresholds are not standardized in the US, but are often standardized outside of the US…”

Childhood Transitions Between Weight Status Categories: Evidence from the UK Millennium Cohort Study

“…Given the increasing prevalence of childhood excess weight and limited resources, the aspirations of governments and decision-makers include prioritizing the implementation of cost-effective strategies for the management of childhood excess weight [ 4 ]. Economic evaluations conducted alongside randomized controlled trials of interventions targeting childhood excess weight tend to assess costs and consequences only over short follow-up periods, missing long-term costs and benefits [ 5 ]. Decision-analytic models can address this limitation by estimating costs and consequences over extended time horizons [ 4 , 6 ].…”

“…Decision-analytic models, in particular, state transition models, are the most frequently used vehicle for the conduct of economic evaluations of interventions targeting childhood excess weight [ 5 ]. State transition models characterize the movements between health states such as underweight, healthy weight, overweight, and obesity over discrete time steps [ 7 ], untangling the complex epidemiological patterns and stochastic processes surrounding chronic disease progression [ 6 , 7 ].…”