Table 5. Cost and cost effectiveness of interventions and policies.
| Author Year |
Study Objective | Setting / Sample | Data source/ Population Reach | Analysis model; Year of Costinga | Key evaluation components | Domains of influence | Outcome measures | Net Results: Impact on Obesity and Cost |
|---|---|---|---|---|---|---|---|---|
| Evaluation type / Intervention | Location | Discount Ratea | Perspectivea | Levels of Influence | ||||
| Ma [48] 2011 |
Estimate lifetime obesity-related medical costs and establish the breakeven cost saving of obesity prevention intervention | US population | Obesity prevalence estimates from 30 000 000 children ages: 0 to 6 Years; 7 to 12 years; 13 to 18 years; NHANES, 2003–2006; MEPS 2006 | Simulation; Year of costing: 2006 US$ | Medical cost perspective | Biological, Behavioral, Healthcare system | Preventing and reducing childhood obesity (defined as ≥ 95th percentile of age- and gender BM) | In healthy 0-6-year-old children, spending up to $339 per child will result in a positive cost benefit. |
| Simulation of an obesity prevention intervention | Discount: medical costs 3% annually | Individual, Interpersonal, Community, Societal | An intervention that results in 1% reduction in obesity in children 0–6 years would result in a $1.7 billion-dollar cost savings | |||||
| Wright [49] 2014 |
Estimate the cost of a cluster RCT, obesity prevention intervention to reduce TV viewing time; fast food SSB intake | Non-profit pediatric offices; Eastern, MA | Children 2.0 to 6.9 years old; BMI ≥ 95th percentile or ≥ 85th < 95th percentile with 1 overweight parent (BMI ≥25) | Cost Study: net cost analysis: difference in cost for the I vs. C group); Year of costing: 2011 US$ | Costs include: Parent time and costs; Provider’s direct visit-related -costs: 4 chronic care visits; 2 phone calls; Educational materials; Interactive website | Biological, Behavioral, Healthcare system | At 1 year, no significant difference in BMI, kg/m2 and BMI z-score; Total I group cost = $65,643 (95% CI, $64,522, $66,842); Total C group cost = $12,192 (95% CI, $11,393, $13,174) | The intervention costs per child, mean I group = $259 (95% CI, $255, $264); C group = $63 (95% CI, $59, $69) |
| Cost Study: based on the High Five for Kids intervention [51] | I group: Sites (n = 5) Children, (n = 253); C group: Sites (n = 5); Children (n = 192) | Discount: medical equipment 3.5% | Societal perspective | Individual, interpersonal | Net difference in cost between I and C: $196; (95% CI, $191, $202) per child | |||
| Cradock [47] 2017 |
Estimate the cost of a national policy to implement the Hip-Hop Jr. physical activity intervention in licensed childcare centers | Child Care Setting; US population | National Association for Regulatory Administration 2013, Census Bureau, MEPS 2001–2003; Implementation cost estimates from similar intervention | Microsimulation modeling of outcomes and costs; Year of costing: 2014 US$ | All intervention costs; State level: training, labor and travel; Program level: training, labor and materials | Biological, Behavioral, Healthcare system | Assumptions based on Hip-Hop results: Reduction in mean BMI (-0.13. SE = 0.11); PA increase in mean mins per day 7.4 (SE = 3.09) | Cases of obesity prevented (2015–2025) 93,065c (95% UI; -88,279, 248,174) |
| CEA: based on the Hip-Hop to Health Jr. intervention (Kong 2016) | 1st year reach: children 3–5 attending licensed child care centers (4.8 million) | Discount: future cost 3% annually | Modified Societal perspective | Individual, Interpersonal, Community, Societal | Cost per BMI unit changed per person $361c (95% UI, $2031, $3454) | |||
| Kuo, [41] 2009 |
Assess the impact of menu-labeling law on population weight gain | Large restaurant chains in LA County, California | LA county Health Survey; California Department of Education Physical Fitness Testing Program (1999 and 2006.) National Restaurant Association | Simulation model | Estimates of total annual revenue, market share, and average meal price of large chain restaurants, total annual revenue; | Biological, Behavioral, Physical/built, Sociocultural | Assumed 10% of customers would order reduced-calorie meals with an average 100 calories reduction | Intervention prevents a total average annual weight gain of 507,500 lbs. in children 5–17 years |
| Policy, city & county wide law: menu labeling | Health impact assessment approach; weight gain averted | Assumed similar weight gain patterns for all school-aged children aged 5 to 17 years | Individual, Interpersonal, Societal | Estimated annual weight gain in children 5–17 years is 1.25 million lbs. | No cost data | |||
| Dharmasena [43] 2012 |
Estimate the impact of a 20% SSB tax, considering the expected effect on other beverages | Four regions in the US (East, Midwest, South and West). | Nielsen Homescan Panel 1998–2003 | Quadratic Almost Ideal Demand System (QUAIDS) model | Estimating direct and indirect effects of a tax on SSB consumption, caloric intake and per capita annual body weight; | Biological, Behavioral | Percent change in per capita consumption of: Regular soda (-49%); High-fat milk (- 2%); Low-fat milk (+ 11%); Fruit Juice (+ 29%); Bottled water (-5%) | Change in body weight, mean -1.54 lbs. per year |
| Direct own-price and indirect cross-price effects on other beverages (milk, fruit juice, sports drinks) | ||||||||
| Policy, National: a tax on SSBs | Individual, Interpersonal, Societal | Net calorie reduction: 449.6 calories per person per month. | No cost data | |||||
| Wright [45] 2015 |
Estimate the health and economic costs of early childcare center obesity prevention policies | Licensed child care facilities in the US; Eligible population- 6.5 million preschool children | U.S. 2012: 2007 census; Child Care Licensing Study; 2005 NAP; NHANES 2009–2012; US Bureau of Labor Statistics 2013; Agriculture Marketing Service, USDA; Beverage, PA and screen time data from research studies; | Simulation: Markov-based cohort modelb; Estimated: licensing, training, and beverage costs; Assumed 73% policy adoption rate; Year of costing: 2014 US$ | Hypothetical policy intervention: for preschoolers attending childcare centers: Replacing SSBs with water, limiting fruit juice to 6 ounces /child/day, serving reduced fat milk; 90 minutes of MVPA /day; limit screen time to 30 min./week | Biological, Behavioral, Physical/built | Policy components’ contribution to change in BMI: PA (28%); Beverage (32%); Screen time (40%); Short term outcomes: First-year intervention cost ($ million): 4.82 (6.02, 12.6); Ten-year (2015–2025) invention cost ($ million): 8.39 (–10.4, 21.9); Net healthcare cost savings ($ million): 51.6 (14.2, 134) | Total BMI units reduced 338,00 (107,000, 790,000); Mean BMI reduction per eligible preschool child: 0.0186 fewer BMI units (0.00592, 0.0434) |
| Policy, National: A multi-component early childhood care center policy intervention | Population reach: 6.50 million preschoolers attending childcare | Discount: healthcare costs 3% annually | Societal perspective | Individual, Interpersonal, Societal | ICER, $57.80 per BMI unit avoided; The intervention is 94.7% likely to yield a cost saving by 2025. | |||
| Sonnenville [42] 2015 |
Estimate the impact of eliminating the TV advertising tax subsidy on BMI | US children and adolescents aged 2–19 years | The Nielsen Company; National Longitudinal Survey of Youth; Rudd Report; US Bureau of Labor Statistics 2013 salary; TV viewing/ advertising data from published studies | Simulation: Markov-based cohort modelb; Year of costing: 2014 US$ | CEA of the elimination of the tax subsidy of TV advertising costs for nutritionally poor foods and beverages during children’s programming (> 35% child -audience share) | Biological, Behavioral | Short term outcomes: First-year intervention cost ($ million): 1.05 (0.69, 1.42); Ten-year (2015–2025): Healthcare cost savings ($ millions) - 352 (-581, -138; Net cost saving per dollar spent ($ million): 38.0 (14.3, 74.3) | Total population BMI units reduced among youth 2–19 years (millions): 2.13 (0.83, 3.52); Mean BMI reduction per youth: 0.028 (0.011, 0.046); Estimated reduction in obesity prevalence: 0.30%. |
| Policy, National: Eliminating the tax subsidy for TV advertising | Population reach: 74 million | Discount: healthcare costs 3% annually | Societal perspective | Individual, Interpersonal, Societal | Two-year costs per BMI unit reduced ($ million): 1.16 (0.51, 2.63) | |||
| Long [44] 2015 |
To quantify health and economic benefits of a national sugar-sweetened beverage excise tax | US population ages 2- adult | NHANES; U.S. Bureau of Labor Statistics 2013; MEPS; Washington and West Virginia State Department of Revenue; SSB intake data from published research studies; | Simulation: Markov-based cohort modelb; Year of costing: 2014 US$ | CEA of the implementing a $0.01/ounce SSB excise tax estimating; The cost and impact of the change in BMI on healthcare costs; Life-years lost DALYs averted; QALYs gained; For the simulation the tax did not apply to 100% juice, milk products, or artificially sweetened beverages | Biological, Behavioral | A tax of $0.01/ounce of SSBs was estimated to result on a 20% (11%, 43%) reduction in baseline SSB consumption; First-year intervention cost ($ million): 51.0 (35.4, 65.5); Ten—year intervention cost (2015–2025). ($ million): 430 (307, 552)-Tax would result in a total healthcare cost savings ($ millions) -23.6 (-54.9, -9.33) | Mean per capita BMI unit reduction for youth 2–19 years of age 0.16 (0.06, 0.37); Estimated 1.38% reduction in youth obesity prevalence rate |
| Policy, National: SSB Excise Tax | Population reach: 313 million | Discount: healthcare costs 3% annually | Societal perspective | Individual, Interpersonal, Societal | Two-year costs per BMI unit reduced among youth ($ million): 8.54 (3.33, 24.2); Every dollar spent on the intervention would result in $55.0 ($21.0, $140.0) in healthcare cost savings | |||
| Toussaint [46] 2017 |
Examine the impact of the school-based changes, on BMI trajectory in elementary school-aged children over 6 years | 6 rural county regions in the Northeast Iowa initiative | Longitudinal cohort data from 4,101 elementary school-aged children (ages 4–12 years) | Linear growth models to determine growth rates; sensitivity analysis to identify program exposure needed to impact BMI growth rates | School policies supporting healthy living, healthy diet and active play; Community resources for healthy, affordable foods; Environment changes to support physical activity and play | Biological, Behavioral, Physical/built | Reported a 0.32 unit increase in BMI (P < .001) for each school grade advanced | Program exposure slowed overall BMI growth rates (P < .05); Program exposure of 1 year or less = BMI growth rate 1.02 (about 5 BMI increase between kindergarten to fifth grade); |
| Program, regional Northeast Iowa Food and Fitness Initiative | Population Reach: 100,000 | Individual, Interpersonal, Community | Program exposure of 2 to 6 years = BMI growth rate of 0.67 (about 3.4 BMI increase from kindergarten to 5th grade); No cost data |
Abbreviations: BMI, Body mass index (kg/m2); C, Comparator group; CEA, cost-effectiveness analysis; DALYs, disability adjusted life-years; I, Intervention; ICER incremental cost-effectiveness ratio; LA, Los Angeles; MA, Massachusetts; MEPS, Medical Expenditure Panel Survey; NAP, Nutrition and Physical Activity Self-Assessment for Child Care; NHANES, National Health and Nutrition Examination Survey; PA, Physical activity; RCT, randomized control study; SSBs, sugar-sweeten beverages; TV, television; USDA, United States Department of Agriculture; QALYS, quality adjusted life-years.
a Year of costing, discount rate and perspective or other key considerations are shown, if applicable
b Applied modified Australian Assessing Cost Effectiveness (ACE) methodologies using U.S. data, and recommendations from the U.S. Panel on Cost-Effectiveness in Health and Medicine to create the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) model.
c Mean and 95% uncertainty intervals reported