Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA
Acad Pediatr. 2011 Jul-Aug;11(4):342-50. doi: 10.1016/j.acap.2011.04.005.
This study seeks to project at what level of effectiveness and cost a population-based or targeted intervention would yield a positive net economic benefit.
Data sources include prevalence of obesity at all ages from the National Health and Nutrition Examination Survey, the persistence of obesity from childhood to adulthood from a literature review, and a cost estimate from the 2006 Medical Expenditures Panel Survey. Econometric analysis was used to estimate medical cost related to obesity. Lifetime medical cost related to obesity is calculated by race, gender, and smoking status. Simulations were conducted to estimate the break-even point for interventions that take place between ages 0 and 6 years, ages 7 and 12 years, and ages 13 to 18 years, with a range of effectiveness.
Results of simulations reveal that, from a pure medical cost perspective, spending approximately $1.4 to $1.7 billion at present value for each birth cohort will break even if 1 percentage point reduction in obesity among children is achieved. Population-based interventions can spend up to between $280 and $339 per child at present value if 1 percentage point reduction in obesity rate could be achieved; in contrast, should we invest in interventions that only target obese children, we can spend up to $1648 to $2735 per obese child for every 1 percentage point reduction in obesity rate.
This study has several important policy implications; early interventions make economic sense. Targeted interventions could yield higher cost savings than population-based interventions for young children (aged 0-6 years), whereas a population-based approach could yield greater economic net benefits for adolescents (aged 13-18 years). Our simulation shows that childhood obesity interventions, even with moderate effectiveness, would make economic sense, which should motivate policy makers to take action.
本研究旨在预测基于人群或有针对性的干预措施在何种效果和成本水平下会产生正向净经济效益。
数据来源包括全国健康和营养检查调查中各年龄段肥胖的流行率、文献综述中从儿童期到成年期肥胖的持续性，以及 2006 年医疗支出面板调查的成本估计。使用计量经济学分析来估计与肥胖相关的医疗成本。根据种族、性别和吸烟状况计算与肥胖相关的终身医疗费用。通过模拟来估计从 0 岁到 6 岁、7 岁到 12 岁以及 13 岁到 18 岁进行干预的盈亏平衡点，干预效果有一定范围。
模拟结果显示，从纯医疗成本的角度来看，如果当前每出生一个队列投入约 14 亿至 17 亿美元，那么儿童肥胖率降低 1 个百分点就可以实现收支平衡。如果肥胖率降低 1 个百分点，基于人群的干预措施可以在当前价值中为每个孩子花费 280 至 339 美元；相比之下，如果我们投资于只针对肥胖儿童的干预措施，那么每降低肥胖率 1 个百分点，每个肥胖儿童可以花费高达 1648 至 2735 美元。
本研究具有几个重要的政策意义；早期干预具有经济意义。对于幼儿（0-6 岁），有针对性的干预措施可能比基于人群的干预措施产生更高的成本节约，而基于人群的方法可能为青少年（13-18 岁）带来更大的经济净效益。我们的模拟表明，即使是效果中等的儿童肥胖干预措施也具有经济意义，这应该促使政策制定者采取行动。
