Abstract
BackgroundUnited States pediatric guidelines recommend that childhood obesity counseling be conducted in the primary care setting. Primary care-based interventions can be effective in improving health behaviors, but also costly. The purpose of this study was to evaluate the cost of a primary care-based obesity prevention intervention targeting children between the ages of two and six years who are at elevated risk for obesity, measured against usual care.MethodsHigh Five for Kids was a cluster-randomized controlled clinical trial that aimed to modify children’s nutrition and TV viewing habits through a motivational interviewing intervention. We assessed visit-related costs from a societal perspective, including provider-incurred direct medical costs, provider-incurred equipment costs, parent time costs and parent out-of-pocket costs, in 2011 dollars for the intervention (n = 253) and usual care (n = 192) groups. We conducted a net cost analysis using both societal and health plan costing perspectives and conducted one-way sensitivity and uncertainty analyses on results.ResultsThe total costs for the intervention group and usual care groups in the first year of the intervention were $65,643 (95% CI [$64,522, $66,842]) and $12,192 (95% CI [$11,393, $13,174]). The mean costs for the intervention and usual care groups were $259 (95% CI [$255, $264]) and $63 (95% CI [$59, $69]) per child, respectively, for a incremental difference of $196 (95% CI [$191, $202]) per child. Children in the intervention group attended a mean of 2.4 of a possible 4 in-person visits and received 0.45 of a possible 2 counseling phone calls. Provider-incurred costs were the primary driver of cost estimates in sensitivity analyses.ConclusionsHigh Five for Kids was a resource-intensive intervention. Further studies are needed to assess the cost-effectiveness of the intervention relative to other pediatric obesity interventions.Trial registrationClinicalTrials.gov Identifier: NCT00377767.
Highlights
United States pediatric guidelines recommend that childhood obesity counseling be conducted in the primary care setting
In response to the growing prevalence of childhood obesity, the 2010 Patient Protection and Affordable Care Act promotes the utilization of preventive care, mandating that insurers cover obesity screening and counseling services as part of insurance policies [1]
A dozen analyses in the peer-reviewed literature detail the costs of delivering childhood obesity interventions
Summary
United States pediatric guidelines recommend that childhood obesity counseling be conducted in the primary care setting. The purpose of this study was to evaluate the cost of a primary care-based obesity prevention intervention targeting children between the ages of two and six years who are at elevated risk for obesity, measured against usual care. The cost of LEAP varies between studies, so we cannot draw definitive conclusions about the affordability of a primary care-based obesity prevention program from those analyses. No analyses have evaluated the cost of primary care-based obesity counseling in the context of the U.S health care system. High Five for Kids was an obesity prevention program developed for 2-6.9 year old children who were obese, or overweight with at least one overweight parent [4]. The aim of this study was to assess the costs associated with implementing the High Five for Kids intervention measured against usual care practices
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