Evaluating the Cost-Effectiveness of Home-Delivered Versus Clinic-Based Pediatric Weight Management in Low-Income Families

Speaker(s)

Johnson T1, French S2, Martin MA3, Lui K4, Bradley L4, Janssen I4, Suzuki S4, Appelhans BM4
1Rush University, Oak Park, IL, USA, 2University of Minnesota, Minneapolis, MN, USA, 3University of Illinois Chicago Department of Pediatrics, Chicago, IL, USA, 4Rush University Medical Center, Chicago, IL, USA

Presentation Documents

OBJECTIVES: Children exposed to socioeconomic disadvantage are at heightened risk for overweight/obesity but face barriers to accessing pediatric weight management programs delivered in a clinic setting. This study aims to determine the cost-effectiveness of a pediatric weight management program delivered in the home compared to the clinic setting for children with overweight/obesity from lower-income households.

METHODS: Creating Healthy Environments for Chicago Kids (CHECK; NCT03195790) was a two-arm parallel group randomized controlled trial. It enrolled households with an annual income at or below 200% of the federal poverty level and at least one child aged 5-12 with a body mass index (BMI) at or above the 85th percentile. Cost-effectiveness from the societal perspective was measured as cost per change in BMI percentile and cost per clinically meaningful reduction in BMI z-score over a 12-month time period. The incremental cost-effectiveness ratio (ICER) was calculated with 95% confidence intervals computed using 1000 bootstrap samples. Sub-analyses were performed by COVID-19 era, and sensitivity analyses varied the hourly wages of parents and interventionists.

RESULTS: Of the 241 families with complete data, mean total cost was $967 (sd=541) for the home-delivered arm and $775 (sd=515) for the clinic-based arm (p<.001). Intervention costs were significantly higher in the home-delivered arm due to interventionist travel costs. The home-delivered arm had greater weight loss overall. The clinic-based setting had lower costs and greater reduction in BMI percentile, translating into an ICER of -$431 (95% CI -3300 to 2902), but had fewer children achieving a clinically meaningful reduction in BMI z-score, translating to an ICER of $229 (-1474 to 1117). The ICERs were sensitive to variations in the hourly wage assumptions.

CONCLUSIONS: Home-delivered interventions incur higher costs due to interventionist travel, while clinic-based interventions face lower family attendance rates.

FUNDING: NIH (NIDDK) grant R01DK111358.

Code

EE161

Topic

Economic Evaluation, Health Policy & Regulatory, Study Approaches

Topic Subcategory

Clinical Trials, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Health Disparities & Equity

Disease

Nutrition, Pediatrics