Utility values for childhood obesity interventions: a systematic review and meta‐analysis of the evidence for use in economic evaluation

Abstract

Rigorous estimates of preference-based utilities are important inputs into economic evaluations of childhood obesity interventions, yet no published review currently exists examining utility by weight status in paediatric populations. A comprehensive systematic literature review and meta-analysis was therefore undertaken, pooling data on preference-based health state utilities by weight status in children using a random-effects model. Tests for heterogeneity were performed, and publication bias was assessed. Of 3,434 potentially relevant studies identified, 11 met our eligibility criteria. Estimates of Cohen's d statistic suggested a small effect of weight status on preference-based utilities. Mean utility values were estimated as 0.85 (95% uncertainty interval [UI] 0.84-0.87), 0.83 (95% UI 0.81-0.85), 0.82 (95% UI 0.79-0.84) and 0.83 (95% UI 0.80-0.86) for healthy weight, overweight, obese and overweight/obese states, respectively. Meta-analysis of studies reporting utility values for both healthy weight and overweight/obese participants found a statistically significant weighted mean difference (0.015, 95% UI 0.003-0.026). A small but statistically significant difference was also estimated between healthy weight and overweight participants (0.011, 95% UI 0.004-0.018). Study findings suggest that paediatric-specific benefits of obesity interventions may not be well reflected by available utility measures, potentially underestimating cost-effectiveness if weight loss in childhood/adolescence improves health or well-being.

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

“…It should be noted that several other studies have found limited evidence of effect of obesity interventions in preschool‐aged children on BMI, although this may be due to factors such as study quality, study duration, choice of outcomes, or implementation issues. We also varied model input parameters regarding HRQoL, given the relatively limited evidence on the association between weight and HRQoL in the literature …”

“…Cohort‐based modelling allowed HRQoL and disease‐related benefits which are not present in early childhood to be estimated assuming lingering BMI effects. The impact on HRQoL of a reduction in BMI was modelled in children using values from the literature . Given the relatively inconclusive evidence of a difference in preference‐based health utilities between healthy weight and obese young children, in the first instance modelling assumed no HRQoL impact in children from 2 to 5 years.…”

“…Given the relatively inconclusive evidence of a difference in preference‐based health utilities between healthy weight and obese young children, in the first instance modelling assumed no HRQoL impact in children from 2 to 5 years. If weight loss was maintained in subsequent years of childhood, health utilities of 0.85 for healthy weight and 0.82 for obesity were then applied between the ages of 6 to 17 years . Given the challenges with the evidence base for estimating health utilities for children with healthy weight and obesity, we also included a scenario with no differences in HRQoL in order to gauge the overall impact on results.…”

“…The impact on HRQoL of a reduction in BMI was modelled in children using values from the literature. 23 Given the relatively inconclusive evidence of a difference in preference-based health utilities between healthy weight and obese young children, in the first instance modelling assumed no HRQoL impact in children from 2 to 5 years. If weight loss was maintained in subsequent years of childhood, health utilities of 0.85 for healthy weight and 0.82 for obesity were then applied between the ages of 6 to 17 years.…”

“…If weight loss was maintained in subsequent years of childhood, health utilities of 0.85 for healthy weight and 0.82 for obesity were then applied between the ages of 6 to 17 years. 23 Given the challenges with the evidence base for estimating health utilities for children with healthy weight and obesity, 23 we also included a scenario with no differences in HRQoL in order to gauge the overall impact on results.…”