Cost-effectiveness of community-based childhood obesity prevention interventions in Australia

Jaithri Ananthapavan, Phuong K. Nguyen, Steven J. Bowe, Gary Sacks, Ana Maria Mantilla Herrera, Boyd Anthony Swinburn, Vicki Brown, Rohan Sweeney, Anita Lal, Claudia Strugnell, Marj Moodie

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives
The objective of this study is to examine, from a limited societal perspective, the cost-effectiveness of community-based obesity prevention interventions (CBIs)-defined as a programme of community-level strategies to promote healthy eating and physical activity for Australian children (aged 5–18 years).

Methods
The effectiveness of CBIs was determined by undertaking a literature review and meta-analysis. Commonly implemented strategies to increase physical activity and improve nutrition were costed (in 2010 Australian dollars) to determine the average cost of a generic programme. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the lifetime of the target population. Monte-Carlo simulation was used to assess second-order uncertainty of input parameters to estimate mean incremental cost-effectiveness ratios (ICER) with 95% uncertainty intervals (UIs). Scenario analyses tested variations in programme intensity, target population, and duration of effect.

Results
The meta-analysis revealed a small but significant difference in BMI z-score (mean difference of − 0.07 (95% UI: − 0.13 to − 0.01)) favouring the CBI community compared with the control. The estimated net cost of implementing CBIs across all local government areas (LGAs) in Australia was AUD426M (95% UI: AUD3M to AUD823M) over 3 years. This resulted in 51,792 HALYs gained (95% UI: 6816 to 96,972) over the lifetime of the cohort. The mean ICER was AUD8155 per HALY gained (95% UI: AUD237 to AUD81,021), with a 95% probability of being cost-effective at a willingness to pay threshold of AUD50,000 per HALY.

Conclusions
CBIs are cost-effective obesity prevention initiatives; however, implementation across Australia will be (relatively) expensive when compared with current investments in preventive health.
Original languageEnglish
Number of pages11
JournalInternational Journal of Obesity
DOIs
Publication statusAccepted/In press - 29 Mar 2019

Cite this

Ananthapavan, J., Nguyen, P. K., Bowe, S. J., Sacks, G., Mantilla Herrera, A. M., Swinburn, B. A., ... Moodie, M. (Accepted/In press). Cost-effectiveness of community-based childhood obesity prevention interventions in Australia. International Journal of Obesity. https://doi.org/10.1038/s41366-019-0341-0
Ananthapavan, Jaithri ; Nguyen, Phuong K. ; Bowe, Steven J. ; Sacks, Gary ; Mantilla Herrera, Ana Maria ; Swinburn, Boyd Anthony ; Brown, Vicki ; Sweeney, Rohan ; Lal, Anita ; Strugnell, Claudia ; Moodie, Marj. / Cost-effectiveness of community-based childhood obesity prevention interventions in Australia. In: International Journal of Obesity. 2019.
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title = "Cost-effectiveness of community-based childhood obesity prevention interventions in Australia",
abstract = "ObjectivesThe objective of this study is to examine, from a limited societal perspective, the cost-effectiveness of community-based obesity prevention interventions (CBIs)-defined as a programme of community-level strategies to promote healthy eating and physical activity for Australian children (aged 5–18 years).MethodsThe effectiveness of CBIs was determined by undertaking a literature review and meta-analysis. Commonly implemented strategies to increase physical activity and improve nutrition were costed (in 2010 Australian dollars) to determine the average cost of a generic programme. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the lifetime of the target population. Monte-Carlo simulation was used to assess second-order uncertainty of input parameters to estimate mean incremental cost-effectiveness ratios (ICER) with 95{\%} uncertainty intervals (UIs). Scenario analyses tested variations in programme intensity, target population, and duration of effect.ResultsThe meta-analysis revealed a small but significant difference in BMI z-score (mean difference of − 0.07 (95{\%} UI: − 0.13 to − 0.01)) favouring the CBI community compared with the control. The estimated net cost of implementing CBIs across all local government areas (LGAs) in Australia was AUD426M (95{\%} UI: AUD3M to AUD823M) over 3 years. This resulted in 51,792 HALYs gained (95{\%} UI: 6816 to 96,972) over the lifetime of the cohort. The mean ICER was AUD8155 per HALY gained (95{\%} UI: AUD237 to AUD81,021), with a 95{\%} probability of being cost-effective at a willingness to pay threshold of AUD50,000 per HALY.ConclusionsCBIs are cost-effective obesity prevention initiatives; however, implementation across Australia will be (relatively) expensive when compared with current investments in preventive health.",
author = "Jaithri Ananthapavan and Nguyen, {Phuong K.} and Bowe, {Steven J.} and Gary Sacks and {Mantilla Herrera}, {Ana Maria} and Swinburn, {Boyd Anthony} and Vicki Brown and Rohan Sweeney and Anita Lal and Claudia Strugnell and Marj Moodie",
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Ananthapavan, J, Nguyen, PK, Bowe, SJ, Sacks, G, Mantilla Herrera, AM, Swinburn, BA, Brown, V, Sweeney, R, Lal, A, Strugnell, C & Moodie, M 2019, 'Cost-effectiveness of community-based childhood obesity prevention interventions in Australia' International Journal of Obesity. https://doi.org/10.1038/s41366-019-0341-0

Cost-effectiveness of community-based childhood obesity prevention interventions in Australia. / Ananthapavan, Jaithri; Nguyen, Phuong K.; Bowe, Steven J.; Sacks, Gary; Mantilla Herrera, Ana Maria; Swinburn, Boyd Anthony; Brown, Vicki; Sweeney, Rohan; Lal, Anita; Strugnell, Claudia; Moodie, Marj.

In: International Journal of Obesity, 29.03.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cost-effectiveness of community-based childhood obesity prevention interventions in Australia

AU - Ananthapavan, Jaithri

AU - Nguyen, Phuong K.

AU - Bowe, Steven J.

AU - Sacks, Gary

AU - Mantilla Herrera, Ana Maria

AU - Swinburn, Boyd Anthony

AU - Brown, Vicki

AU - Sweeney, Rohan

AU - Lal, Anita

AU - Strugnell, Claudia

AU - Moodie, Marj

PY - 2019/3/29

Y1 - 2019/3/29

N2 - ObjectivesThe objective of this study is to examine, from a limited societal perspective, the cost-effectiveness of community-based obesity prevention interventions (CBIs)-defined as a programme of community-level strategies to promote healthy eating and physical activity for Australian children (aged 5–18 years).MethodsThe effectiveness of CBIs was determined by undertaking a literature review and meta-analysis. Commonly implemented strategies to increase physical activity and improve nutrition were costed (in 2010 Australian dollars) to determine the average cost of a generic programme. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the lifetime of the target population. Monte-Carlo simulation was used to assess second-order uncertainty of input parameters to estimate mean incremental cost-effectiveness ratios (ICER) with 95% uncertainty intervals (UIs). Scenario analyses tested variations in programme intensity, target population, and duration of effect.ResultsThe meta-analysis revealed a small but significant difference in BMI z-score (mean difference of − 0.07 (95% UI: − 0.13 to − 0.01)) favouring the CBI community compared with the control. The estimated net cost of implementing CBIs across all local government areas (LGAs) in Australia was AUD426M (95% UI: AUD3M to AUD823M) over 3 years. This resulted in 51,792 HALYs gained (95% UI: 6816 to 96,972) over the lifetime of the cohort. The mean ICER was AUD8155 per HALY gained (95% UI: AUD237 to AUD81,021), with a 95% probability of being cost-effective at a willingness to pay threshold of AUD50,000 per HALY.ConclusionsCBIs are cost-effective obesity prevention initiatives; however, implementation across Australia will be (relatively) expensive when compared with current investments in preventive health.

AB - ObjectivesThe objective of this study is to examine, from a limited societal perspective, the cost-effectiveness of community-based obesity prevention interventions (CBIs)-defined as a programme of community-level strategies to promote healthy eating and physical activity for Australian children (aged 5–18 years).MethodsThe effectiveness of CBIs was determined by undertaking a literature review and meta-analysis. Commonly implemented strategies to increase physical activity and improve nutrition were costed (in 2010 Australian dollars) to determine the average cost of a generic programme. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the lifetime of the target population. Monte-Carlo simulation was used to assess second-order uncertainty of input parameters to estimate mean incremental cost-effectiveness ratios (ICER) with 95% uncertainty intervals (UIs). Scenario analyses tested variations in programme intensity, target population, and duration of effect.ResultsThe meta-analysis revealed a small but significant difference in BMI z-score (mean difference of − 0.07 (95% UI: − 0.13 to − 0.01)) favouring the CBI community compared with the control. The estimated net cost of implementing CBIs across all local government areas (LGAs) in Australia was AUD426M (95% UI: AUD3M to AUD823M) over 3 years. This resulted in 51,792 HALYs gained (95% UI: 6816 to 96,972) over the lifetime of the cohort. The mean ICER was AUD8155 per HALY gained (95% UI: AUD237 to AUD81,021), with a 95% probability of being cost-effective at a willingness to pay threshold of AUD50,000 per HALY.ConclusionsCBIs are cost-effective obesity prevention initiatives; however, implementation across Australia will be (relatively) expensive when compared with current investments in preventive health.

U2 - 10.1038/s41366-019-0341-0

DO - 10.1038/s41366-019-0341-0

M3 - Article

JO - International Journal of Obesity

JF - International Journal of Obesity

SN - 0307-0565

ER -