Sharifi Mona, Franz Calvin, Horan Christine M, Giles Catherine M, Long Michael W, Ward Zachary J, Resch Stephen C, Marshall Richard, Gortmaker Steven L, Taveras Elsie M
Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
Eastern Research Group Inc, Lexington, Massachusetts.
Pediatrics. 2017 Nov;140(5). doi: 10.1542/peds.2016-2998.
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.
评估在全国范围内实施加速研究技术（STAR）干预措施对儿童肥胖症的成本效益和人群影响。
在STAR整群随机试验中，在儿科诊所就诊的6至12岁肥胖儿童，若初级保健提供者有基于电子健康记录（EHR）的决策支持，且父母有自我引导的行为改变支持，其体重指数（BMI）的增加显著小于接受常规护理的儿童。我们使用了一个微观模拟模型，模拟2015年至2025年在美国所有具备全功能EHR的儿科初级保健提供者中全国性实施STAR的情况，以估计成本、对肥胖患病率的影响以及成本效益。
预计10年全国性实施的人群覆盖范围约为200万儿童，干预成本为每名儿童119美元，BMI单位降低237美元。在10年时，假设效果维持不变，预计该干预措施将避免43000例肥胖病例和226000个肥胖相关生命年，每避免一例肥胖病例的净成本为4085美元，每避免一个肥胖相关生命年的净成本为774美元。将实施范围限制在大型诊所并采用更高的EHR采用率估计值，可提高成本效益和覆盖范围，而降低干预措施效果的维持程度则会使成本效益变差。
一种为临床医生提供电子决策支持并为父母提供自我引导行为改变支持的儿童肥胖干预措施可能比以往的临床干预措施更具成本效益。针对肥胖儿童的有效且高效的干预措施是必要的，并且可以与人群层面的预防策略协同作用，以加速在降低肥胖患病率方面取得进展。
