Abstract
The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for policy implementation. The Assessing Cost-Effectiveness (ACE) approach to priority-setting was used. Systematic literature reviews were undertaken to assess the evidence of intervention effectiveness on body mass index and/or physical activity for selected interventions. A standardised evaluation framework was used to assess the cost-effectiveness of each intervention compared to a ‘no intervention’ comparator, from a limited societal perspective. A multi-state life table Markov cohort model was used to estimate the long-term health impacts (quantified as health adjusted life years (HALYs)) and health care cost-savings resulting from each intervention. In addition to the technical cost-effectiveness results, qualitative assessments of implementation considerations were undertaken. All 16 interventions evaluated were found to be cost-effective (using a willingness-to-pay threshold of AUD50,000 per HALY gained). Eleven interventions were dominant (health promoting and cost-saving). The incremental cost-effectiveness ratio for the non-dominant interventions ranged from AUD1,728 to 28,703 per HALY gained. Regulatory interventions tended to rank higher on their cost-effectiveness results, driven by lower implementation costs. However, the program-based policy interventions were generally based on higher quality evidence of intervention effectiveness. This comparative analysis of the economic credentials of obesity prevention policies for Australia indicates that there are a broad range of policies that are likely to be cost-effective, although policy options vary in strength of evidence for effectiveness, affordability, feasibility, acceptability to stakeholders, equity impact and sustainability. Implementation of these policies will require sustained co-ordination across jurisdictions and multiple government sectors in order to generate the predicted health benefits for the Australian population.
Highlights
The obesity epidemic is firmly established with the prevalence of overweight and obesity nearly tripling over the last four decades [1, 2]
Intervention selection was based on the potential impact of the intervention on overweight and obesity in Australia; the relevance of the intervention to current policy decision-making across Australian government jurisdictions and the private sector; and the availability of adequate evidence of intervention effectiveness to support the analyses
The two multi-component programmatic interventions (‘Community–based interventions’ and ‘Financial incentives for weight loss provided by private health insurers’) impacted both physical activity and nutrition, the evidence of effectiveness was limited to body mass index (BMI) outcomes and only the intervention’s impact on BMI was modelled
Summary
The obesity epidemic is firmly established with the prevalence of overweight and obesity nearly tripling over the last four decades [1, 2]. Australia has the fifth highest prevalence of obesity among countries in the Organisation for Economic Co-operation and Development (OECD) [3], with approximately 63% of the adult population and 27% of children experiencing either overweight or obesity [4]. There is global consensus that efforts to address obesity require a comprehensive societal response [8, 9]. This includes government policies across a wide range of sectors, such as health, education, agriculture, transport, trade and finance, as well as wide-scale action from the private sector and community groups [10]. In order to inform evidence based decision-making, governments require evidence on the effectiveness of potential actions, and their cost-effectiveness to prioritise the options for change that offer best value for money [12]
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