Quality assessment of economic evaluations of health promotion programs for children and adolescents—a systematic review using the example of physical activity

Abstract

An increasing number of primary prevention programs aimed at promoting physical exercise in children and adolescents are being piloted. As resources are limited, it is important to ascertain the costs and benefits of such programs. The aim of this systematic review is to evaluate the currently available evidence on the cost-effectiveness of programs encouraging physical activity in children and adolescents and to assess their quality. A systematic review was conducted searching in well established literature databases considering all studies before February 2015. Citation tracking in Google Scholar and a manual search of the reference lists of included studies were used to consolidate this. The fundamental methodological elements of the included economic evaluations were extracted, and the quality of the included studies was evaluated using the Pediatric Quality Appraisal Questionnaire (PQAQ). In total, 14 studies were included. Considering the performance of the economic evaluation, the studies showed wide variation. Most of the studies used a societal perspective for their analyses and discounted costs and effects. The findings ranged from US$11.59 for a person to become more active (cheapest intervention) up to US$669,138 for a disability adjusted life year (DALY) saved (most expensive intervention), with everything in between. Overall, the results of three studies are below a value of US$3061, with one of them even below US$200.00, for the achieved effects. For the other programs, the context-specific assessment of cost-effectiveness is problematic as there are different thresholds for cost-effectiveness in different countries or no clearly defined thresholds at all. There are multiple methodological difficulties involved in evaluating the cost-effectiveness of interventions aimed at increasing physical activity, which results in little consistency between different evaluations. The quality of the evaluations ranged from poor to excellent while a large majority of them was of very good methodological quality. Better comparability could be reached by greater standardization, especially regarding systematic consideration of implementation costs.

Protocol for a systematic review of methods and cost-effectiveness findings of economic evaluations of obesity prevention and/or treatment interventions in children and adolescents

“…Seven recent reviews [ 5 , 19 – 24 ] have summarised the cost-effectiveness of obesity prevention and/or treatment interventions in young people; however, none have used or reported rigorous methods for conducting their reviews. Only two of them consider accounting for costs occurring across different sectors [ 5 , 23 ]. Five of the previous reviews had restrictions based on language criteria [ 5 , 19 – 21 , 23 ] and four of the previous reviews explicitly excluded studies that were conducted in developing countries within their exclusion criteria [ 5 , 19 , 21 , 23 ].…”

“…Only two of them consider accounting for costs occurring across different sectors [ 5 , 23 ]. Five of the previous reviews had restrictions based on language criteria [ 5 , 19 – 21 , 23 ] and four of the previous reviews explicitly excluded studies that were conducted in developing countries within their exclusion criteria [ 5 , 19 , 21 , 23 ]. Only three of the reviews used established criteria, e.g.…”

“…Drummond or Philips to assess the quality of the primary studies, and used preventative steps to minimise bias and errors in the quality assessment process [ 5 , 20 , 23 ]. The search strategy was adequate and appropriate in over half of the reviews (4/7) [ 5 , 20 , 22 , 23 ]. However, several more relevant databases could have been searched to ensure that all studies were identified.…”

“…Another review focused on economic evaluations of physical activity programmes as a primary prevention approach for obesity in children and adolescents [ 23 ]. This did not provide detailed information about the numbers of interventions that were cost-effective.…”

Expert opinions on good practice in evaluation of health promotion and primary prevention measures related to children and adolescents in Germany

“…Two recent systematic reviews exist on this topic (e.g. [ 6 , 7 ]), which found only two economic evaluations for health promotion programs targeting children and adolescents in Germany [ 8 , 9 ]. A much higher number of evaluations would have been expected, as for example, a relatively high number of prevention programs is listed in the “KNP-Projektdatenbank”, which includes all projects that were funded within the German interdisciplinary Prevention Research Funding Program, and thus gives an excellent overview of the German prevention landscape.…”