Economic Evaluation of Obesity Prevention in Early Childhood: Methods, Limitations and Recommendations

Abstract

Despite methodological advances in the field of economic evaluations of interventions, economic evaluations of obesity prevention programmes in early childhood are seldom conducted. The aim of the present study was to explore existing methods and applications of economic evaluations, examining their limitations and making recommendations for future cost-effectiveness assessments. A systematic literature search was conducted using PubMed, Cochrane Library, the British National Health Service Economic Evaluation Databases and EconLit. Eligible studies included trial-based or simulation-based cost-effectiveness analyses of obesity prevention programmes targeting preschool children and/or their parents. The quality of included studies was assessed. Of the six studies included, five were intervention studies and one was based on a simulation approach conducted on secondary data. We identified three main conceptual and methodological limitations of their economic evaluations: Insufficient conceptual approach considering the complexity of childhood obesity, inadequate measurement of effects of interventions, and lack of valid instruments to measure child-related quality of life and costs. Despite the need for economic evaluations of obesity prevention programmes in early childhood, only a few studies of varying quality have been conducted. Moreover, due to methodological and conceptual weaknesses, they offer only limited information for policy makers and intervention providers. We elaborate reasons for the limitations of these studies and offer guidance for designing better economic evaluations of early obesity prevention.

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

“…To date, most obesity prevention programmes have been targeted at older children or adults, with a small but growing body of research into the effectiveness of intervention strategies in preschool‐aged children . There is currently also very limited evidence on the cost‐effectiveness of obesity prevention interventions in younger children, with the recent systematic review by Doring et al finding only six published studies undertaking economic evaluations of obesity interventions including early childhood populations.…”

“…When undertaking economic evaluation, the time horizon for consideration of the costs and benefits is important and has a bearing on the economic results presented. 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 .…”

Why Early Prevention of Childhood Obesity Is More Than a Medical Concern: A Health Economic Approach

“…Most of these studies evaluate the economic consequences of school programs, finding that they were indeed cost-effective. However, the number of cost-effectiveness studies targeting preschool children is small [10] , with only a few economic evaluations of infant feeding as early obesity prevention. For the US, for example, Bartick and Reinhold [11] estimated that compared to formula, breastfeeding would result in substantial cost savings.…”

“…It is therefore essential to develop a new framework for economic evaluations that goes beyond evaluating randomized control trials. Second, only few interventions have proven to be (significantly) effective in preventing overweight and obesity, particularly when looking at long-term effectiveness [10] . While small effect sizes are clinically less important, economic evaluations are still of great relevance.…”

“…First, given the complexity of childhood obesity and key obesogenic environments, conventional approaches commonly used in economic evaluations during adulthood may be of limited use [10] . For instance, Sonntag et al [13] have shown that obesityrelated dietary behavior in childhood is influenced not only by parents but also by 5 key obesogenic environments: schools, television, the internet, retailers, and advertising campaigns.…”