Systematic review and overview of health economic evaluation models in obesity prevention and therapy

Abstract

Given the increasing clinical and economic burden of obesity, it is of major importance to identify cost-effective approaches for obesity management. Areas covered: This study aims to systematically review and compile an overview of published decision models for health economic assessments (HEA) in obesity, in order to summarize and compare their key characteristics as well as to identify, inform and guide future research. Of the 4,293 abstracts identified, 87 papers met our inclusion criteria. A wide range of different methodological approaches have been identified. Of the 87 papers, 69 (79%) applied unique /distinctive modelling approaches. Expert commentary: This wide range of approaches suggests the need to develop recommendations /minimal requirements for model-based HEA of obesity. In order to reach this long-term goal, further research is required. Valuable future research steps would be to investigate the predictiveness, validity and quality of the identified modelling approaches.

A New Model for Evaluation of Interventions to Prevent Obesity in Early Childhood

“…A range of modeling methodologies have been used in economic evaluation of obesity prevention and treatment, yet there have been very few modeled economic evaluations for children (22). Most models take a Markov approach (22–24) in which populations are moved through the model as cohorts of identical population groups that transition through states representing healthy weight, overweight and obesity.…”

“…A range of modeling methodologies have been used in economic evaluation of obesity prevention and treatment, yet there have been very few modeled economic evaluations for children (22). Most models take a Markov approach (22–24) in which populations are moved through the model as cohorts of identical population groups that transition through states representing healthy weight, overweight and obesity. A major contribution to this literature has been provided by the Assessing Cost Effectiveness (ACE) studies (25) which have used consistent methods and a common modeling platform (a proportional multi-state life table approach) to assess cost-effectiveness of a number of different interventions in childhood (26–28).…”

“…At the core of our proposed model framework is an epidemiological model that predicts BMI trajectories through annual gain in weight (BMI) based on child age, sex, socioeconomic position, and current weight status. The EPOCH model takes the approach, that change in BMI is directly associated with costs and effects, rather than simulating chronic disease events as these will generally not become apparent until adulthood (22). The BMI trajectory model and quality of life sub-models have been completed and are described below; other sub-models for projection of direct and indirect healthcare costs will be successively added.…”

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

“…Whilst the costs of childhood obesity interventions are incurred immediately, assumptions around the sustained impact of such interventions are problematic and may be unrealistic given the relative lack of evidence of long term effect . Whilst modelled economic evaluations of childhood obesity interventions inherently rely on assumptions to fill in the evidence gaps, the estimation of longer‐term health‐related costs and benefits provides important information for resource allocation purposes . By not considering the costs and benefits of early childhood obesity prevention over longer time horizons, it may be possible that the economic credentials of such interventions are not being fully recognized.…”

“…12 Whilst modelled economic evaluations of childhood obesity interventions inherently rely on assumptions to fill in the evidence gaps, the estimation of longer-term health-related costs and benefits provides important information for resource allocation purposes. 13 By not considering the costs and benefits of early childhood obesity prevention over longer time horizons, it may be possible that the economic credentials of such interventions are not being fully recognized. Sound modelling practice, with transparent assumptions, variability around model input parameters to take into account uncertainty and heterogeneity and comprehensive sensitivity analyses to gauge impact on overall results, can assist when limited evidence is available to inform decisions.…”