Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand.
Wellington School of Medicine, University of Otago, Wellington, New Zealand.
Obes Res Clin Pract. 2018 May-Jun;12(3):293-298. doi: 10.1016/j.orcp.2018.04.001. Epub 2018 May 17.
To determine whether Whānau Pakari, a home-based, 12-month multi-disciplinary child obesity intervention programme was cost-effective when compared with the prior conventional hospital-based model of care.
Whānau Pakari trial participants were recruited January 2012-August 2014, and randomised to either a high-intensity intervention (weekly sessions for 12 months with home-based assessments and advice, n=100) or low-intensity control (home-based assessments and advice only, n=99). Trial participants were aged 5-16 years, resided in Taranaki, Aotearoa/New Zealand (NZ), with a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities. Conventional group participants (receiving paediatrician assessment with dietitian input and physical activity/nutrition support, n=44) were aged 4-15 years, and resided in the same or another NZ centre. The change in BMI standard deviation score (SDS) at 12 months from baseline and programme intervention costs, both at the participant level, were used for the economic evaluation. A limited health funder perspective with costs in 2016 NZ$ was taken.
The per child 12-month Whānau Pakari programme costs were significantly lower than in the conventional group. In the low-intensity group, costs were NZ$939 (95% CI: 872, 1007) (US$648) lower than the conventional group. In the high-intensity intervention group, costs were NZ$155 (95% CI: 89, 219) (US$107) lower than in the conventional group. BMI SDS reductions were similar in the three groups.
A home-based, multi-disciplinary child obesity intervention had lower programme costs per child, greater reach, with similar BMI SDS outcomes at 12 months when compared with the previous hospital-based conventional model.
比较家庭为基础的为期 12 个月的多学科儿童肥胖干预项目 Whānau Pakari 与先前的传统医院护理模式，确定 Whānau Pakari 是否具有成本效益。
Whānau Pakari 试验参与者于 2012 年 1 月至 2014 年 8 月招募，并随机分为高强度干预组（12 个月内每周进行一次，包括家庭评估和建议，n=100）或低强度对照组（仅进行家庭评估和建议，n=99）。试验参与者年龄为 5-16 岁，居住在新西兰塔拉纳基（Taranaki），体重指数（BMI）≥第 98 百分位数或 BMI>第 91 百分位数且存在与体重相关的合并症。常规组参与者（接受儿科医生评估，营养师提供饮食建议，以及进行体育活动/营养支持，n=44）年龄为 4-15 岁，居住在同一或另一个新西兰中心。从基线到 12 个月的 BMI 标准差评分（SDS）变化和参与者层面的方案干预成本用于经济评估。采用有限的卫生基金视角，以 2016 年新西兰元（NZD）计算成本。
Whānau Pakari 方案的每个孩子 12 个月的成本明显低于常规组。在低强度组，成本比常规组低 939 新西兰元（95%CI：872，1007）（648 美元）。高强度干预组的成本比常规组低 155 新西兰元（95%CI：89，219）（107 美元）。三组的 BMI SDS 降低幅度相似。
与先前的基于医院的传统模式相比，基于家庭的多学科儿童肥胖干预方案每例儿童的方案成本更低，覆盖范围更广，在 12 个月时 BMI SDS 结果相似。
