Summary: Cost-Effectiveness of a Clinical Childhood Obesity Intervention

A CHOICES study estimates that the national implementation of an intervention focused on electronic health record (EHR)-based decision support for primary care providers and self-guided behavior change support for parents is likely a more cost-effective approach to treating children with obesity than previous clinical interventions reporting cost information.

Cost-Effectiveness of a Clinical Childhood Obesity Intervention.
Sharifi M, Franz C, Horan CM, Giles C, Long M, Ward Z, Resch S, Marshall R, Gortmaker S, Taveras E. Pediatrics. 2017; 140(5):e20162998.
Abstract 

Over 12 million children and adolescents in the United States have obesity (17% of the population). The results of this study demonstrate that taking advantage of electronic health record (EHR) systems may be among the “best value for money” strategies currently tested for pediatric obesity treatment.

“It is clear that the most cost-effective strategies for preventing new cases of obesity are population-level approaches like taxes and school-based policies,” said Mona Sharifi, lead author and Assistant Professor of Pediatrics at the Yale School of Medicine. “However, we need additional and different strategies to support the approximately 12 million children who already have obesity and are at highest risk for health complications and obesity in adulthood. Our study suggests that using the electronic health record to help primary care pediatricians deliver higher quality care for children with obesity may be relatively low hanging fruit among clinical interventions in terms of cost-effectiveness.”

 

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The Study of Technology to Accelerate Research (STAR)1 involved modifications to existing EHR systems to facilitate childhood obesity management in pediatric primary care by prompting diagnosis as well as providing decision support and electronic resources for evaluation, management, and follow-up care. Evidence obtained in a cluster randomized controlled trial showed that STAR helped to prevent excess weight gain compared to usual care.

The CHOICES study of STAR offers an opportunity to both inform clinicians and policymakers about what investment would be required to adopt STAR in pediatric practices across the country and evaluate the cost-effectiveness and population impact of the intervention, if implemented nationally over 10 years from 2015-2025. Some of the key outcomes include:

  • Cases of obesity averted in 2025: 43,000
  • Life-years with obesity averted (2015-2025): 226,000
  • Cost per BMI unit reduced: $237
  • Mean BMI unit reduction: -0.5
  • 10-year reach: 2 million
  • Total health care costs saved (over 10 years): $64 million
  • 10-year net cost (the cost of implementation minus the health care cost saved): $175 million
  • Cost per child: $119

As more pediatric practices adopt fully functional EHRs (fueled by federal goals and incentives), the results indicate even greater reach and population health benefits, even if implementation is limited to large practices.

Overall, there is evidence that STAR can reduce the prevalence of childhood obesity by focusing on high-risk children, providing electronic decision support for pediatricians, and supplying self-guided behavior change strategies for parents to utilize outside of the clinical setting. Limited cost effectiveness information on other similar clinical interventions indicates that STAR is likely to have a higher magnitude of effect on improving children’s health at a lower cost per child.

STAR is one of 13 interventions that have been evaluated using CHOICES methods. While many strategies focused on preventing childhood obesity are more cost-effective than STAR, the projected impact of the STAR intervention on the prevalence of obesity is high and intervention costs are low when compared with other clinical interventions focused on treatment of obesity, such as bariatric surgery.

References:

  1. Taveras EM, Marshall R, Kleinman KP, et al. Comparative effectiveness of childhood obesity interventions in pediatric primary care: A cluster-randomized clinical trial. JAMA Pediatr. 2015;169(6):535-542.