Moodie Marjory, Haby Michelle, Wake Melissa, Gold Lisa, Carter Robert
Health Economics Unit, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia.
Econ Hum Biol. 2008 Dec;6(3):363-76. doi: 10.1016/j.ehb.2008.06.001. Epub 2008 Jun 21.
To assess from a societal perspective the incremental cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children. The intervention was modelled on the LEAP (live, eat and play) trial, a randomised controlled trial conducted by the Centre for Community Child Health, Melbourne, Australia in 2002-2003. This study was undertaken as part of the assessing cost-effectiveness (ACE) in obesity project which evaluated, using consistent methods, 13 interventions targeting unhealthy weight gain in children and adolescents.
A logic pathway was used to model the effects of the intervention compared to no intervention on body mass index (BMI) and health outcomes (disability-adjusted life years-DALYs). Disease costs and health benefits were tracked until the cohort of eligible children reached the age of 100 years or death. Simulation-modelling techniques were used to present a 95% uncertainty interval around the cost-effectiveness ratio. The intervention was also assessed against a series of filters ('equity', 'strength of evidence', 'acceptability', 'feasibility', sustainability' and 'side-effects') to incorporate additional factors that impact on resource allocation decisions.
The intervention, as modelled, reached 9685 children aged 5-9 years with a BMI z-score of >or=3.0, and cost $AUD6.3M (or $AUD4.8M excluding time costs). It resulted in an incremental saving of 2300 BMI units which translated to 511 DALYs. The cost-offsets stemming from the intervention totalled $AUD3.6M, resulting in a net cost per DALY saved of $AUD4670 (dominated; $0.1M) (dominated means intervention costs more for less effect).
Compared to a 'no intervention' control group, the intervention was cost-effective under current assumptions, although the uncertainty intervals were wide. A key question related to the long-term sustainability of the small incremental weight loss reported, based on the 9-month follow-up results for LEAP.
从社会角度评估针对超重和中度肥胖儿童的家庭医生介导干预措施的增量成本效益。该干预措施以LEAP（生活、饮食和运动）试验为蓝本，LEAP试验是澳大利亚墨尔本社区儿童健康中心于2002 - 2003年进行的一项随机对照试验。本研究是肥胖症项目评估成本效益（ACE）的一部分，该项目采用一致的方法对13项针对儿童和青少年不健康体重增加的干预措施进行了评估。
使用逻辑路径对干预措施与不干预措施在体重指数（BMI）和健康结果（伤残调整生命年 - DALYs）方面的效果进行建模。追踪疾病成本和健康效益，直至符合条件的儿童队列达到100岁或死亡。采用模拟建模技术给出成本效益比周围95%的不确定性区间。还针对一系列筛选标准（“公平性”、“证据强度”、“可接受性”、“可行性”、“可持续性”和“副作用”）对干预措施进行评估，以纳入影响资源分配决策的其他因素。
按照模型，该干预措施覆盖了9685名5 - 9岁、BMI z评分≥3.0的儿童，成本为630万澳元（或不包括时间成本为480万澳元）。这导致BMI单位增量节省2300个，相当于511个伤残调整生命年。干预措施产生的成本抵消总计360万澳元，导致每节省一个伤残调整生命年的净成本为4670澳元（占优；10万澳元）（占优意味着干预措施效果较差但成本更高）。
与“不干预”对照组相比，在当前假设下该干预措施具有成本效益，尽管不确定性区间较宽。基于LEAP试验9个月的随访结果，一个关键问题涉及所报告的小幅度体重减轻的长期可持续性。
