Cost and effectiveness of treatment options for childhood obesity
Article first published online: 18 MAR 2013
© 2013 The Authors. Pediatric Obesity © 2013 International Association for the Study of Obesity
Volume 9, Issue 1, pages e26–e34, February 2014
How to Cite
Hollinghurst, S., Hunt, L. P., Banks, J., Sharp, D. J. and Shield, J. P. (2014), Cost and effectiveness of treatment options for childhood obesity. Pediatric Obesity, 9: e26–e34. doi: 10.1111/j.2047-6310.2013.00150.x
- Issue published online: 21 JAN 2014
- Article first published online: 18 MAR 2013
- Manuscript Accepted: 30 JAN 2013
- Manuscript Revised: 22 JAN 2013
- Manuscript Received: 4 SEP 2012
- NIHR Research for Patient Benefit
- BUPA Foundation
- costs and cost analysis;
- hospital care;
- primary health care
- Approximately one-fifth of children in the UK are obese.
- There are currently few, effective interventions available in the UK.
- There are very little data on relative cost-effectiveness of childhood obesity interventions, which hampers the commissioning of future services.
- Simple multi-component obesity interventions can be provided at relatively low cost per 0.1 body mass index standard deviation score (BMI SDS) improvement.
- More intensive and effective interventions incur greater cost per 0.1 BMI SDS reduction but this may be justified given the improved overall BMI SDS reduction attained.
To describe the costs and outcomes of three models of care for childhood obesity previously evaluated in two 2-arm pilot randomized trials in England. The treatments were (i) a hospital clinic (control in both trials), comprising a multidisciplinary team of consultant, dietitian and exercise specialist; (ii) a nurse-led primary care clinic replicating the service provided by the hospital and (iii) an intensive intervention using Mandometer®, a behaviour modification tool aimed at encouraging slower eating and better recognition of satiety.
Patient-level data on resources used to deliver each intervention were collected during the trials. Apart from the cost of the Mandometer® the majority of cost was staff time, dependent on discipline and grade. Outcome for both trials was body mass index standard deviation score (BMI SDS) measured at 12 months.
Cost and outcome data were available for 143 children in total. Cost per child was £1749 (SD £243) in the Mandometer® group, £301 (£76) in the primary care group, and £263 (£88) and £209 (£81) in the hospital groups. Mean reduction in BMI SDS was 0.40 (0.35), 0.17 (0.26), 0.15 (0.25) and 0.14 (0.32), respectively.
Intensive management using Mandometer® was effective but costly (£432 per 0.1 reduction in BMI SDS) compared to conventional care (range £153–£173). A total of 26% children receiving conventional care achieved a clinically meaningful reduction in BMI SDS; however, use of Mandometer® training may be justified in children not responding to conventional lifestyle interventions.