Economic evaluation of “healthy beginnings” an early childhood intervention to prevent obesity

Hayes, Alison; Lung, Thomas; Wen, Li Ming; Baur, Louise A.; Rissel, Chris; Howard, Kirsten

doi:10.1002/oby.20747

Cited by 38 publications

(77 citation statements)

References 21 publications

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“…This early intervention was effective in reducing children’s body mass index and reducing TV viewing at age 2 years [22], as well as improving infant feeding practices including breastfeeding [25]. However, the economic evaluation of the HBT showed that the early obesity prevention through home visits was only moderately cost-effective, with the cost of home visiting potentially limiting the level of population reach [26]. Hence, other new, low cost and high uptake approaches need to be explored.…”

Section: Introductionmentioning

confidence: 99%

A 3-Arm randomised controlled trial of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants to prevent childhood obesity

et al. 2017

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BackgroundWith an increasing prevalence of obesity in young children globally, there is an urgent need for the development of effective early interventions. A previous Healthy Beginnings Trial using a nurse-led home visiting program has demonstrated that providing mothers with evidence-based advice can improve maternal practice regarding obesity prevention, and can reduce Body Mass Index (BMI) in the first few years of life. However, the costs for scale-up of home visiting limit its population reach. This trial aims to determine the efficacy of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants in improving infant feeding practices and preventing the early onset of childhood overweight and obesity.Methods/DesignWe propose a 3-arm randomised controlled trial (RCT) with a consecutive sample of 1056 mothers with their newborn children in New South Wales (NSW) Australia. Pregnant women who are between weeks 28 and 34 of their pregnancy will be invited to participate in the CHAT trial. Informed consent will be obtained, and after baseline data collection, participants will be randomly allocated to the telephone intervention, text messaging intervention, or the control group. The intervention comprises telephone consultations or text messages, together with 6 intervention packages being mailed at specific times from the third trimester of pregnancy until 12 months post birth. The main trial outcome measures include a) duration of breastfeeding, b) timing of introduction of solids, c) nutrition behaviours, physical activity and television viewing, and d) weight and BMI z-score at 12 and 24 months, e) cost-effectiveness, as well as f) feasibility and acceptability of the interventions.DiscussionThe results will ascertain whether early intervention using telephone consultation or text messaging together with staged mailed intervention resources can be feasible and effective in improving infant feeding practices, physical activity and reducing children’s BMI in the early years of life. If proven to be feasible, effective as well as cost-effective, the trial results will inform a series of recommendations for policy and practice related to promoting healthy infant feeding and physical activity in young children in the first years of life.Trial registrationThe CHAT Trial is registered with the Australian Clinical Trial Registry (ACTRN12616001470482p). It was registered on October 21, 2016.

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Section: Introductionmentioning

confidence: 99%

A 3-Arm randomised controlled trial of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants to prevent childhood obesity

et al. 2017

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“…A total of 369 children were recruited to the economic sub‐study. Consent for health‐care data linkage was obtained for 363 participants; of these, 13 did not have successful linkage to either Medicare or CHeRel, leaving 350 participants (95%) for analysis . Child, maternal and household characteristics of the participants at baseline are shown in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Socio‐demographic characteristics were collected prior to birth or at the first post‐natal visit, using standard questions from the New South Wales (NSW) Population Health Survey . As there were no differences in health‐care costs or health‐care utilisation (adjusted incidence rate ratio = 0.97, P = 0.24) between the intervention and control participants, data were combined from both arms of the trial in the present analyses.…”

Section: Methodsmentioning

confidence: 99%

Patterns and costs of health‐care utilisation in Australian children: The first 5 years

Hayes

Brown

Tan

et al. 2018

J Paediatrics Child Health

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Aim To describe patterns of health‐care utilisation and costs of a cohort of Australian children in the first 5 years of life and to investigate demographic factors associated with high health‐care utilisation. Methods This was a secondary data analysis of prospectively linked health‐care utilisation data, including primary and secondary health‐care consults, hospitalisations and emergency. The subjects were 350 children from a disadvantaged area of Sydney. Outcomes were the frequency and cost of all health‐care consults from birth to 5 years of age. Multivariable logistic regression examined the odds of being a high health‐care user in relation to child and family characteristics. Results Children had more health‐care consults and higher annual health‐care costs in the first 2 years of life (mean 12 health‐care visits per year, mean cost Australian dollars (AUD) 1400 per child) than in the next 3 years (8 visits per year, AUD 900 per child). Primary care consults formed 86% of all health‐care encounters but only contributed to 30% of the total costs. Factors positively associated with frequent use of health care in the first 2 years of life included being male, mother not married/de facto and annual household income of less than AUD 40000. Frequent users mostly accessed primary care services. There was no association between demographic factors and frequent use of health care in years 3–5 of life. Conclusions Children from low‐income or single‐parent families may require additional support services during the first 2 years of life. Maintaining or increasing access to free or very low‐cost primary health‐care services for disadvantaged families will promote equity in health.

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“…Trial‐based economic evaluations consider the costs and outcomes within the randomized controlled trial's (RCT's) observation time . This provides useful information on the more immediate cost‐effectiveness of interventions, often reporting findings related to outcomes in the shorter‐term such as cost per unit of weight gain or body mass index (BMI) point avoided during the study timeframe or follow‐up period . Whilst these types of evaluations are well suited to inform the technical efficiency of studies (i.e how to best maximize outcomes with a given set of resources), they do not provide information on how to best allocate those resources (ie, allocative efficiency).…”

Section: Introductionmentioning

confidence: 99%

The potential for long‐term cost‐effectiveness of obesity prevention interventions in the early years of life

et al. 2019

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Summary Background Early childhood obesity prevention is gaining increasing importance, as the prevalence of children with overweight and obesity aged 5 years and under increases worldwide. Along with understanding the effectiveness of obesity interventions, it is important to understand the cost‐effectiveness of interventions over time. Objectives To estimate the long‐term health benefits and health care cost‐savings of reductions in BMI for the Australian population of children aged between 2 and 5 years. Methods A proportional multistate, multiple cohort lifetable model estimated the health benefits and health care cost‐savings related to hypothetical reductions in BMI, informed by a scoping review of systematic reviews reporting the effectiveness of obesity prevention interventions in preschool aged children. Results Results suggest significant potential for cost‐effectiveness of obesity prevention interventions in preschool‐aged children if intervention effect can be maintained. A relatively small population level reduction in BMI z‐score (−0.13 BMIz) in children aged 2 to 5 years would result in 36 496 health‐adjusted life years saved (95% uncertainty interval [UI], 30 283‐42 945) and health care cost‐savings of approximately $301 million (95% UI $234 million‐$369 million) if modelled over the lifetime. Conclusions Scenario results highlight the importance of obesity intervention in the early years of life.

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Economic evaluation of “healthy beginnings” an early childhood intervention to prevent obesity

Cited by 38 publications

References 21 publications

A 3-Arm randomised controlled trial of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants to prevent childhood obesity

A 3-Arm randomised controlled trial of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants to prevent childhood obesity

Patterns and costs of health‐care utilisation in Australian children: The first 5 years

The potential for long‐term cost‐effectiveness of obesity prevention interventions in the early years of life

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