Obesity is one of the defining health challenges of our generation. Studies project that, if current trends continue, more than 50% of the US population will have obesity within the next 20 years.
Cost-Effectiveness of a Clinical Childhood Obesity Intervention
Mona Sharifi, MD, MPH, Calvin Franz, PhD, Christine M. Horan, MPH, Catherine M. Giles, MPH, Michael W. Long, ScD, Zachary J. Ward, MPH, Stephen C. Resch, PhD, Richard Marshall, MD, Steven L. Gortmaker, PhD, Elsie M. Taveras, MD, MPH, 2018. "Cost-Effectiveness of a Clinical Childhood Obesity Intervention", Obesity: Stigma, Trends, and Interventions, American Academy of Pediatrics
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To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity.
In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness.
The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention’s effect worsened the former.
A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence.