Assessing Cost-Effectiveness in Obesity (ACE-Obesity): an overview of the ACE approach, economic methods and cost results

Abstract

BackgroundThe aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study.MethodsThe Assessing Cost Effectiveness (ACE) approach combines technical rigour with 'due process' to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their 'current practice' comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were 'equity', 'strength of the evidence', 'feasibility of implementation', 'acceptability to stakeholders', 'sustainability' and 'potential for side-effects'.ResultsThe intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum) and when expressed as a 'cost per child' estimate (from <AUD1.0 [reduction of TV advertising of high fat foods/high sugar drinks] to AUD31,553 [laparoscopic adjustable gastric banding for morbidly obese adolescents]). High costs per child reflected cost structure, target population and/or under-utilisation.ConclusionThe use of consistent methods enables valid comparison of potential intervention costs and cost-offsets for each of the interventions. ACE-Obesity informs policy-makers about cost-effectiveness, health impact, affordability and 2nd stage filters for important options for preventing unhealthy weight gain in children. In related articles cost-effectiveness results and second stage filter considerations for each intervention assessed will be presented and analysed.

Economic evaluation of lifestyle interventions to treat overweight or obesity in children

“…Previous studies have attempted to determine the potential long-term cost effectiveness of interventions aimed at treating overweight or obese children, but these studies have largely assessed interventions that have not been evaluated in RCTs. 12 However, without RCT evidence of public health effectiveness the meaning of the cost-effective analysis is unclear.…”

Modeling Social Transmission Dynamics of Unhealthy Behaviors for Evaluating Prevention and Treatment Interventions on Childhood Obesity

“…The intervention costs in this study were lower compared with other similar intervention studies [10,22]. A study of a 3-year, after-school program to prevent obesity among elementary school students [10] reported the net intervention costs per capita was $317 and the achieved effectiveness was a 0.7% PBF reduction.…”

Role of Policy and Government in the Obesity Epidemic

“…Here, we discuss 2 areas that have been identified as strategies 6,[15][16][17][18] for cost-effective population-level change: taxes on sugary drinks and restrictions on marketing to children.…”

“…6 The Assessing Cost-Effectiveness (ACE) studies of obesity and of noncommunicable disease prevention identified the 3 most cost-effective policy interventions as a tax on unhealthy foods and beverages, a front-of-pack "traffic light" nutrition labeling system, and a reduction of marketing of unhealthy foods and beverages to children. 6,15,16 Recent reports from the Organization for Economic Cooperation and Development also support the idea that regulatory and fiscal policy could reduce obesity by improving defaults for the whole population. 17,18 The role of defaults in obesity prevention is presented visually in Figure 2, which is adapted from Swinburn and colleagues' recent article in The Lancet.…”