Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial

Abstract

Background Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach. Conclusions This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial Registration ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855

Cost‐effectiveness analysis of individual‐level obesity treatment in paediatrics: A scoping review

“…nutrition, physical activity, habit change; n = (24, 57%)). Four of the 35 included economic evaluations had a telehealth component ( n = 4, 10%) 17–19 …”

Economic and health impacts of the Change4Life Food Scanner app: Findings from a randomized pilot and feasibility study

“…Maintenance costs were assumed to be 25% of app development costs, amounting to £16,200. On the other hand, Tully et al ( 24 ) estimated app development costs at approximately €11,000, whilst maintenance costs were estimated at approximately €2000 (15–20% of app development costs). Additional costs were also flagged, such as cloud data storage).…”

“…Evaluations of health promotion apps are lacking ( 24 ). The Change4Life Food Scanner app was first released as part of a mass media campaign by Public Health England (PHE), a UK Government agency ( 25 ).…”

Leveraging seasonality and timing to optimize pediatric weight management interventions: Novel directions for future research

“…The use of mHealth and telehealth visits may mitigate some barriers (e.g., transportation) associated with traditional in‐person treatment 21 . However, new barriers arise, such as cost and digital access, that may limit the impact of mHealth and telehealth for racial and ethnic minority youth, and those from lower‐income backgrounds 21,22 . Further, 26 contact hours of intervention likely remains challenging for families to coordinate and access, whether in person or virtual.…”