Abstract
Childhood obesity is a major clinical and economic health concern. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector. This study is one of the first efforts to provide evidence by assessing the effects and costs of a population-based primary prevention intervention targeting pre-school children attending child health centers in Sweden. The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among pre-school children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period from a societal perspective. The primary outcome was BMI at age 4. Cost data was prospectively collected alongside the trial. Scenario analyses were carried out to identify uncertainty. The estimated additional mean total costs of the PRIMROSE intervention were 342 Euro (95% CI: 334; 348) per child. During pre-school years direct costs mainly consist of training costs and costs for the additional time used by nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents' absence from work due to their participation in the intervention. The incremental cost-effectiveness ratio in the base case analysis was 3,109 Euro per 1 BMI unit prevented. We cannot provide evidence that the PRIMROSE intervention is cost-effective, given the uncertainty in the effect measure. Until further evidence is provided, we recommend resources to be spent elsewhere within the field of obesity prevention. Furthermore, to achieve valid and reliable cost-effectiveness results, the economic evaluation of obesity prevention programs in early childhood should incorporate the life time impact to capture all relevant costs and benefits.
Highlights
Despite signs of stabilization [1, 2], the burden of childhood overweight is still considerable in many westernized countries
This paper describes an economic evaluation of the PRIMROSE cluster-randomized primary prevention trial, where the costs and outcomes of the intervention were compared with those of usual care from a societal perspective
The PRIMROSE trial evaluated the effectiveness of an early childhood obesity intervention delivered in the first 4 years of life, embedded in regular child health services in Sweden
Summary
Despite signs of stabilization [1, 2], the burden of childhood overweight is still considerable in many westernized countries. In a recent systematic review, only six studies addressing the cost-effectiveness of obesity prevention programs in early childhood were identified, and only three of them were based on a randomized trial [11] This paper aims to critically assess the costs and evaluate the economic benefits of a populationbased primary prevention intervention embedded in regular child health services targeting first time parents and their children. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector.
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