Section of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Int J Obes (Lond). 2012 Apr;36(4):524-8. doi: 10.1038/ijo.2011.263. Epub 2012 Jan 17.
To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification.
All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses.
Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4% of the adolescents were selected for intensive pediatric care, 1.4% for individual clinical interventions in primary health care, 14.0% for individual primary obesity prevention using the Internet and 82.1% for population-based interventions. Costs for the cross-sectional selection strategy were projected to USD463 581 per 1000 adolescents and for the trajectory-based strategy were USD 302 016 per 1000 adolescents.
Using projections from epidemiological data, we found that by basing the selection of adolescents for obesity prevention on weight trajectories, the load on highly specialized pediatric care can be reduced by one-third and total health service costs for obesity management among adolescents reduced by one-third. Before use in policies and prevention program planning, our findings warrant confirmation in prospective cost-benefit studies.
利用流行病学数据和标准化经济模型，比较使用横断面体重分类选择 15 岁青少年与纵向分类选择青少年进行肥胖预防的预期成本。
研究纳入了所有 1991 年在瑞典一个县（人口 44 万）出生、在 5 岁、10 岁和 15 岁时参加了所有常规身高和体重测量的儿童（n=4312）。通过计算来自各级医疗保健系统提供者的肥胖预防服务的供应所产生的预期财务负担，比较了两种选择策略。分析的主要终点是每 1000 名儿童的边际成本差异。
使用横断面选择策略，15 岁的青少年中有 3.8%被选择由儿科专家进行评估，96.2%被选择进行基于人群的干预。在基于轨迹的策略中，2.4%的青少年被选择接受强化儿科护理，1.4%被选择在初级保健中进行个体临床干预，14.0%被选择通过互联网进行个体初级肥胖预防，82.1%被选择进行基于人群的干预。横断面选择策略的成本预计为每 1000 名青少年 463581 美元，而基于轨迹的策略为每 1000 名青少年 302016 美元。
使用流行病学数据的预测，我们发现，通过将青少年肥胖预防的选择基于体重轨迹，高度专业化儿科护理的负担可以减少三分之一，青少年肥胖管理的总医疗服务成本可以减少三分之一。在用于政策和预防计划规划之前，我们的研究结果需要在前瞻性成本效益研究中得到证实。
