Purpose: To evaluate the cost-effectiveness of High Five for Kids, a primary care obesity prevention program that targeted 2-6 year old children at elevated risk for obesity.
Method: To conduct a trial-based incremental cost-effectiveness analysis, we used the 1-year results of a cluster-randomized controlled clinical trial in 10 pediatric practices in Massachusetts. The obesity prevention intervention consisted chiefly of 4 chronic care visits and 2 telephone calls with parents of 2-6 year old children at elevated risk for obesity. The intervention was conducted by trained nurse practitioners and aimed to modify nutrition and TV viewing habits. The primary endpoint was change in age-adjusted body mass index (BMI (kg/m2)) for the intervention (n= 253) versus usual care (n=192) groups. We assessed costs, including direct medical, materials, parent time, and transportation costs, in 2009 dollars. We used a societal perspective and conducted one-way sensitivity and sampling uncertainty analyses.
Result: The mean increase in age-adjusted BMI was 0.31 (95% CI [0.13, 0.49]) in the intervention group and 0.49 (95% CI [0.30, 0.68]) in usual care, with a difference of -0.19 kg/m2 (95% CI [-0.50, 0.12]). The costs of the intervention and usual care programs were $281 (95% CI [$276, $285]) per child and $5.33 per child (95% CI [$5.33, $5.33]), respectively. The incremental cost-effectiveness ratio for the primary endpoint was $1,452/unit of BMI saved. Uncertainty analyses revealed that the intervention was dominated by usual care in 9.4% of cases. Cost-effectiveness results were sensitive to materials and interviewer time costs. Secondary analyses that included training costs did not substantially change the results.
Conclusion: After the first of two planned years of intervention, the High Five for Kids program was not demonstrably effective and was more costly than usual care. Future research should consider the effect of longer time horizons and extend the analysis to include quality-adjusted life years as an endpoint. A decision analytic model to simulate the effect of persistence of health benefits over time could provide further insights into the cost-effectiveness of similar interventions.
Candidate for the Lee B. Lusted Student Prize Competition
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