Background: Whilst many studies investigate the effectiveness of interventions to improve nutrition and healthy eating in children and adolescents, few studies examine their cost effectiveness. This systematic review aimed to explore the methods used to conduct economic evaluations including long-term modelling of costs and health benefits of dietary population-level interventions within this age group.
Methods: Eleven peer-reviewed databases and five databases of the grey literature were reviewed between November 2018 and January 2019. A study was included if it: 1) was an economic evaluation alongside a clinical trial or modelling study based on a single effectiveness study, 2) evaluated an obesity-prevention dietary intervention, 3) targeted the general population of children aged 218 years, and 4) was conducted in a high-income country. Two reviewers independently screened studies, extracted data and assessed the quality of economic evaluations and decision-analytic models.
Results: A total of 20 papers met the inclusion criteria, comprising of 19 separate studies. All studies were school-based interventions, except for three, which were school and community based. Only four interventions strictly focused on diet and nutrition, whilst the remainder additionally incorporated a physical activity component. Eight studies conducted an economic evaluation alongside a clinical trial and 11 studies modelled long-term health and cost outcomes. Evaluations varied in methodological approaches. This included methods to predict, measure and value long-term benefits in adulthood from short-term clinical outcomes in childhood. Methods in which costs had been incorporated, inclusion of obesity-related disease states and calculations predicting their occurrence varied considerably between studies. Most commonly applied sensitivity analyses included variation of intervention effectiveness parameters and reductions in intervention effects with simulation time.
Conclusions: Heterogeneity in evaluation methods and techniques can lead to difficulties in direct comparison, as well as substantial differences of cost-effectiveness outcomes. The findings from this review provides a resource that can be utilised by researchers as a foundation for future evaluation and model developments for the evaluation of UK policies and interventions.
Keywords: Childhood obesity prevention, diet, systematic review, economic evaluation
Disclosures: This research is funded by the Wellcome Trust Doctoral Training Programme in Public Health, Health Economics and Decision Sciences.
12 Sep 2019 - 13 Sep 2019