Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme.
Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme.
Objective To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents. Design A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted. Participants A hypothetical cohort of 100 adolescents with a mean age of 13 years. Interventions An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling. Outcome measure Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained. Results The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane. Conclusions The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting. Trail registration number ISRCTN74109264.
general diabetes, health economics, mental health, nutrition & dietetics, public health
Kalita, Neelam
da42f168-a3cc-44c9-bafb-2801ff57914b
Cooper, Keith
ea064f58-d71d-404a-bcf3-49d243b8825b
Baird, Janis
f4bf2039-6118-436f-ab69-df8b4d17f824
Woods-Townsend, Kathryn
af927fa3-30b6-47d9-8b4d-4d254b3a7aab
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Inskip, Hazel
5fb4470a-9379-49b2-a533-9da8e61058b7
Barker, Mary
374310ad-d308-44af-b6da-515bf5d2d6d2
Lord, Joanne
fd3b2bf0-9403-466a-8184-9303bdc80a9a
August 2022
Kalita, Neelam
da42f168-a3cc-44c9-bafb-2801ff57914b
Cooper, Keith
ea064f58-d71d-404a-bcf3-49d243b8825b
Baird, Janis
f4bf2039-6118-436f-ab69-df8b4d17f824
Woods-Townsend, Kathryn
af927fa3-30b6-47d9-8b4d-4d254b3a7aab
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Inskip, Hazel
5fb4470a-9379-49b2-a533-9da8e61058b7
Barker, Mary
374310ad-d308-44af-b6da-515bf5d2d6d2
Lord, Joanne
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Kalita, Neelam, Cooper, Keith, Baird, Janis, Woods-Townsend, Kathryn, Godfrey, Keith, Cooper, Cyrus, Inskip, Hazel, Barker, Mary and Lord, Joanne
,
EACH-B study group.
(2022)
Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme.
BMJ Open, 12 (8), [e052611].
(doi:10.1136/bmjopen-2021-052611).
Abstract
Objective To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents. Design A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted. Participants A hypothetical cohort of 100 adolescents with a mean age of 13 years. Interventions An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling. Outcome measure Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained. Results The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane. Conclusions The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting. Trail registration number ISRCTN74109264.
Text
BMJ Open Main Document_EACH B_June2022_Final
- Accepted Manuscript
Text
e052611.full
- Version of Record
More information
Accepted/In Press date: 17 July 2022
e-pub ahead of print date: 5 August 2022
Published date: August 2022
Additional Information:
Funding Information:
The research is funded by the National Institute for Health Research (RP-PG-0216-20004). HI and KG are funded by the UK Medical Research Council (MC_UU_12011/4). KG is supported by the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042), NIHR Southampton 1000DaysPlus Global Nutrition Research Group (17/63/154) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004)), the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP) and the British Heart Foundation (RG/15/17/3174).
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Keywords:
general diabetes, health economics, mental health, nutrition & dietetics, public health
Identifiers
Local EPrints ID: 468547
URI: http://eprints.soton.ac.uk/id/eprint/468547
ISSN: 2044-6055
PURE UUID: bd47b490-986a-4fce-bf76-705d1047614b
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Date deposited: 17 Aug 2022 17:17
Last modified: 06 Jun 2024 01:54
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Corporate Author: EACH-B study group.
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