COST-EFFECTIVENESS OF INTERVENTIONS AGAINST CHILDHOOD OBESITY

OBJECTIVES: To estimate values for cost and effectiveness that assess the long-term efficiency of public health intervention to prevent and correct childhood obesity.  METHODS: A Markov model was developed that takes into account five diseases strongly associated with obesity: Diabetes Mellitus Type 2, Heart Disease, Breast Cancer, Colon Cancer and Stroke. Selection of disease was in base of high rates of morbidity and mortality. In the model, we considered 2 main states: normal weight (BMI < 30 kg/m2) and obese (BMI >= 30 kg/m2). From them, individuals can transit to states which representing the 5 diseases and death. Individuals can transit between normal weight and obese until they reach a certain age (30) when they can transit to the rest of states. The time horizon was 70 years. A literature review was performed in order to estimate parameters. The measure of effectiveness was QALYs and a discount of 3% was applied to costs and utilities. A 2-way probabilistic sensitivity analysis was made over 2 parameters which define the intervention: relative risk and cost of intervention. Also, a multivariate and probabilistic sensitivity analysis by 2nd order Monte Carlo (MC) simulations was performed for all parameters. Finally, acceptability curves and the expected value of perfect information were calculated. RESULTS: If the willingness to pay is € 30,000/QALY, any intervention that exceeds 1% prevention/correction, incurring in cost not exceeding € 2 per child and per year should be implemented, because the probability of hitting the decision is over 90% and does not incur on any opportunity cost. CONCLUSIONS: Long term efficient public health interventions, to prevent/correct childhood obesity, are low cost (not exceeding € 5 per child per year) due to the effectiveness of interventions, usually lower than 2% of prevention/correction over non-intervention.