Economic evaluation of a childhood obesity prevention programme for children: Results from the WAVES cluster randomised controlled trial conducted in schools

Canaway, Alastair; Frew, Emma; Lancashire, Emma; Pallan, Miranda; Hemming, Karla; Adab, Peymané

doi:10.1371/journal.pone.0219500

Cited by 20 publications

(25 citation statements)

References 24 publications

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“…The economic evaluation of the Healthy Caregivers-Healthy Children (HC2) program, which is an early childcare center-based obesity prevention program, suggested that the HC2 intervention shows potential for generating cost savings [42]. One study (the WAVES study) [43] assessing the cost-effectiveness of a multi-faceted school-based obesity prevention intervention targeting children aged 6-7 years suggested that more research to explore obesity prevention within schools as part of a wider systems approach to obesity prevention are needed. One study also assessed the cost-effectiveness of a large, multifaceted, community-based capacity-building demonstration program (Be Active Eat Well (BAEW)) and suggested that BAEW was affordable and cost-effective [44].…”

Section: Secondary Outcomesmentioning

confidence: 99%

Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis

et al. 2020

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The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: −0.12; 95% CI: −0.18 to −0.06; 32 studies; 33,039 participants; I2 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m2 (MD: −0.41 kg/m2; 95% CI: −0.60 to −0.21; 35 studies; 47,499 participants; I2 98%; low quality evidence), and body weight (MD: −1.59; 95% CI: −2.95 to −0.23; 17 studies; 35,023 participants; I2 100%; low quality evidence). Behavioral therapy alone (MD: −0.07; 95% CI: −0.14 to −0.00; 19 studies; 8569 participants; I2 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: −0.08; 95% CI: −0.16 to −0.00; 9 studies; 7334 participants; I2 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: −0.13; 95% CI: −0.25 to −0.01; 5 studies; 1806 participants; I2 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: −0.13; 95% CI: −0.20 to −0.06; 12 studies; 1084 participants; I2 0%; moderate quality evidence), and might reduce BMI (MD: −0.88; 95% CI: −1.265 to −0.50; 34 studies; 3846 participants; I2 72%) and body weight (MD: −3.01; 95% CI: −5.56 to −0.47; 16 studies; 1701 participants; I2 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: −0.08; 95% CI: −0.16 to −0.00; 8 studies; 466 participants; I2 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: −0.16; 95% CI: −0.26 to −0.07; 4 studies; 329 participants; I2 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: −0.09; 95% CI: −0.14 to −0.05; 13 studies; 2995 participants; I2 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.

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Section: Secondary Outcomesmentioning

confidence: 99%

Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis

et al. 2020

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“…We are unaware of other obesity prevention interventions delivered in infancy that have reported cost‐utility ICERs; however, a school‐based physical activity intervention for primary‐aged children in the UK reported an ICER of £26,815 (A$54,894, US$38,307) per QALY (43), indicating poorer cost‐utility than the Sleep intervention and better cost‐utility than the Combination intervention.…”

Section: Discussionmentioning

confidence: 99%

Cost‐Effectiveness of a Novel Sleep Intervention in Infancy to Prevent Overweight in Childhood

Tan

Taylor

et al. 2020

Obesity

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Objective The purpose of this study was to determine, from a health funder perspective, whether a sleep intervention, delivered in infancy, either alone or in combination with food, activity, and breastfeeding advice was cost‐effective compared with usual care. Methods A cost‐effectiveness analysis was conducted alongside the Prevention of Overweight in Infancy (POI) randomized controlled trial for outcomes at 5 years and cost‐effectiveness was modeled to age 15 years using the Early Prevention of Obesity in Childhood microsimulation model. Intervention costs for the Sleep (n = 192), Combination (n = 196), and control (n = 209) groups were determined in 2018 Australian dollars. Incremental cost‐effectiveness ratios (ICERs) were determined for BMI outcomes at 5 and 15 years, with the primary outcome being quality‐adjusted life years (QALYs) modeled over 15 years. Results The average costs of the Sleep and Combination interventions were $184 and $601 per child, respectively. The ICER for the Sleep intervention was $18,125 per QALY gained, with a 74% probability of being cost‐effective at a willingness‐to‐pay threshold of $50,000 per QALY. The ICER for the Combination intervention was $94,667 per QALY gained with a 23% probability of being cost‐effective. Conclusions The POI Sleep intervention, without additional advice, was a low‐cost and cost‐effective approach to reducing childhood obesity. Sleep modification programs offer a very promising approach to obesity prevention in children.

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“…Speci cally, there are no comparable economic evaluations of implementation-interventions in this setting focussed on childhood obesity. More broadly, there are published economic evaluations of early childhood obesity prevention interventions conducted in other countries (49)(50)(51) and these studies are typically inconclusive in their assessment of cost-effectiveness given uncertainty in measures of effect.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines.

Reeves

Edmunds

Szewczyk

et al. 2020

Preprint

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Abstract Background Despite the known benefits of healthy eating in childhood, few Australian childcare services provide food that is consistent with dietary guidelines. The effectiveness of a web-based menu planning intervention to increase childcare service provision of healthy foods, and decrease provision of discretionary foods in long daycare centres in Australia was assessed in a randomised controlled trial. Here we consider the costs, consequences, cost-effectiveness and budget impact of the intervention using data collected within the trial. Methods The prospective trial-based economic evaluation involved 54 childcare services across New South Wales (NSW), Australia. Services were randomised to a 12-month intervention or usual care. The intervention involved access to a web-based menu planning and decision support tool, and online resources. Effectiveness measures included: mean number of food groups, overall menu and individual food group compliance with dietary guidelines, and mean servings of food groups at 12 months. Costs (reported in $AUD, 2017/18) were evaluated from both health sector and societal perspectives. The direct cost to support uptake of the intervention was calculated, as were costs to each childcare centres. The incremental cost of the intervention was calculated as the net difference in the cost to undertake menu planning and review plus the direct cost of the intervention. Incremental cost–effectiveness ratios (ICERs) including uncertainty intervals, were estimated for differences in costs and effects between intervention and control groups. A relative value index was calculated to determine overall value for money. Results Over the 12 months of the trial, we calculated a difference in cost between usual practice and intervention groups of -$482 (95% UI -$859, -$56). While the measured increase in menu and food group compliance within the trial did not reach statistical significance, there were significant improvements in mean servings of fruit and discretionary food, represented in the cost-consequence analysis. The calculated relative value index of 1.1 suggests that the intervention returns acceptable value for money for the outcomes generated. Conclusion Compared to usual practice, web-based programs may offer an efficient and sustainable alternative for childcare centres to improve the provision of healthy foods to children in their care. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000974404

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Economic evaluation of a childhood obesity prevention programme for children: Results from the WAVES cluster randomised controlled trial conducted in schools

Cited by 20 publications

References 24 publications

Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis

Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis

Cost‐Effectiveness of a Novel Sleep Intervention in Infancy to Prevent Overweight in Childhood

Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines.

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